In vitro temperature evaluation during cement augmentation of proximal humerus plate screw tips

Background

The treatment of proximal humerus fractures in patients with poor bone quality remains a challenge in trauma surgery. Augmentation with polymethylmethacrylate (PMMA) cement is a possible method to strengthen the implant anchorage in osteoporotic bone and to avoid loss of reduction and reduce the cut-out risk. The polymerisation of PMMA during cement setting leads, however, to an exothermic reaction and the development of supraphysiological temperatures may harm the bone and cartilage. This study addresses the issue of heat development during augmentation of subchondrally placed proximal humerus plate screws with PMMA and the possible risk of bone and cartilage necrosis and apoptosis.

Methods

Seven fresh frozen humeri from geriatric female donors were instrumented with the proximal humerus interlocking system (PHILOS) plate and placed in a 37 °C water bath. Thereafter, four proximal perforated screws were augmented with 0.5 ml PMMA each. During augmentation, the temperatures in the subchondral bone and on the articular surface were recorded with K-type thermocouples. The measured temperatures were compared to threshold values for necrosis and apoptosis of bone and cartilage reported in the literature.

Results

The heat development was highest around the augmented tips of the perforated screws and diminished with growing distance from the cement cloud. The highest temperature recorded in the subchondral bone reached 43.5 °C and the longest exposure time above 42 °C was 86 s. The highest temperature measured on the articular surface amounted to 38.6 °C and the longest exposure time above 38 °C was 5 min and 32 s.

Conclusion

The study shows that augmentation of the proximal screws of the PHILOS plate with PMMA leads to a locally limited development of supraphysiological temperatures in the cement cloud and closely around it. The critical threshold values for necrosis and apoptosis of cartilage and subchondral bone reported in the literature, however, are not reached. In order to avoid cement extravasation, special care should be taken in detecting perforations or intra-articular cracks in the humeral head.     

Ultrasound-guided microwave ablation for abdominal wall metastatic tumors: a preliminary study

AIM: To evaluate the feasibility, safety and efficacy of ultrasound-guided microwave (MW) ablation for abdominal wall metastatic tumors.METHODS: From August 2007 to December 2010, a total of 11 patients with 23 abdominal wall nodules (diameter 2.59 cm ± 1.11 cm, range 1.3 cm to 5.0 cm) were treated with MW ablation. One antenna was inserted into the center of tumors less than 1.7 cm, and multiple antennae were inserted simultaneously into tumors 1.7 cm or larger. A 21 gauge thermocouple was inserted near important organs which required protection (such as bowel or gallbladder) for real-time temperature monitoring during MW ablation. Treatment outcome was observed by contrast-enhanced ultrasound and magnetic resonance imaging (MRI) [or computed tomography (CT)] during follow-up.RESULTS: MW ablation was well tolerated by all patients. Six patients with 11 nodules had 1 thermocouple inserted near important organs for real-time temperature monitoring and the maximum temperature was 56 °C. Major complications included mild pain (54.5%), post-ablation fever (100%) and abdominal wall edema (25%). All 23 tumors (100%) in this group were completely ablated, and no residual tumor or local recurrence was observed at a median follow-up of 13 mo (range 1 to 32 mo). The ablation zone was well defined on contrast-enhanced imaging (contrast-enhanced CT, MRI and/or contrast-enhanced ultrasound) and gradually shrank with time.CONCLUSION: Ultrasound-guided MW ablation may be a feasible, safe and effective treatment for abdominal wall metastatic tumors in selected patients.     

Drilling of bone: A comprehensive review

BackgroundBone fracture treatment usually involves restoring of the fractured parts to their initial position and immobilizing them until the healing takes place. Drilling of bone is common to produce hole for screw insertion to fix the fractured parts for immobilization. Orthopaedic drilling during surgical process causes increase in the bone temperature and forces which can cause osteonecrosis reducing the stability and strength of the fixation.MethodsA comprehensive review of all the relevant investigations carried on bone drilling is conducted. The experimental method used, results obtained and the conclusions made by the various researchers are described and compared.ResultReview suggests that the further improvement in the area of bone drilling is possible. The systematic review identified several consequential factors (drilling parameters and drill specifications) affecting bone drilling on which there no general agreement among investigators or are not adequately evaluated. These factors are highlighted and use of more advanced methods of drilling is accentuated. The use of more precise experimental set up which resembles the actual situation and the development of automated bone drilling system to minimize human error is addressed.ConclusionIn this review, an attempt has been made to systematically organize the research investigations conducted on bone drilling. Methods of treatment of bone fracture, studies on the determination of the threshold for thermal osteonecrosis, studies on the parameters influencing bone drilling and methods of the temperature measurement used are reviewed and the future work for the further improvement of bone drilling process is highlighted.     

A pilot evaluation study of high resolution digital thermal imaging in the assessment of burn depth

Thermal imaging is a tool that can be used to determine burn depth. We have revisited the use of this technology in the assessment of burns and aim to establish if high resolution, real-time technology can be practically used in conjunction with clinical examination to determine burn depth. 11 patients with burns affecting upper and lower limbs and the anterior and posterior trunk were included in this study. Digital and thermal images were recorded at between 42 h and 5 days post burn. When compared to skin temperature, full thickness burns were significantly cooler (p < 0.001), as were deep partial thickness burns (p < 0.05). Superficial partial thickness burns were not significantly different in temperature than non-burnt skin (p > 0.05). Typically, full thickness burns were 2.3 °C cooler than non-burnt skin; deep partial thickness burns were 1.2 °C cooler than non-burnt skin; whilst superficial burns were only 0.1 °C cooler. Thermal imaging can correctly determine difference in burn depth. The thermal camera produces images of high resolution and is quick and easy to use.     

金属细针对射频消融离体猪肝热场的影响

目的观察金属细针对射频消融（RFA）离体猪肝热场的影响,探索利用金属细针引导产生适形消融范围的新方法。方法对11个离体家猪肝脏行RFA,以射频电极为对称轴,在射频针一侧按不同距离插入多根22GChiba针作为实验组,对称一侧正常肝脏作为对照组。对实验组所有Chiba针均进行针体绝缘处理,以针尾连接回路电极板的Chiba针组为A亚组,不连接回路电极板的Chiba针组为B亚组。分别对实验组和对照组的消融范围进行大体标本测量和光镜组织学分析,比较其差别。结果Chiba针与射频电极距离≤2．5cm时,A亚组的消融范围明显大于对照组（P〈0．05）,B亚组的消融范围与对照组差异均无统计学意义（P均〉0．05）;Chiba针与射频针距离〉2．5cm时,实验组与对照组消融范围基本一致（P均〉0．05）。结论与回路电极板形成直接电流回路的金属细针在与射频电极一定距离内可增强射频消融热效应,不形成直接电流回路的金属细针不会对射频消融造成明显热影响。     

Generation of a thermostable,oral Zika vaccine that protects against virus challenge in non-human primates

Here we report the development of a thermally stable, orally administered, candidate Zika vaccine using human serotype 5 adenovirus (AdHu5). We engineered AdHu5 to express the genes for the envelope and NS1 proteins of Zika virus. AdHu5 was formulated using a proprietary platform, OraPro, comprising a mix of sugars and modified amino acids that can overcome elevated temperatures (37 C), and an enteric coated capsule that protects the integrity of the AdHu5 from the acid in the stomach. This enables the delivery AdHu5 to the immune system of the small intestine. We show that oral delivery of AdHu5 elicited antigen-specific serum IgG immune responses in a mouse model and in a non-human primate model. Importantly, these immune responses were able reduce viral counts in mice and to prevent detectable viraemia in the non-human primates on challenge with live Zika virus. This candidate vaccine has significant advantages over many current vaccines that are maintained in a cold or ultra-cold chain and require parenteral administration.     

Impact of prognostic nutritional index on survival in recurrent glioblastoma

BackgroundPrimary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types. We aimed to evaluate the prognostic value of Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent glioblastoma patients treated with systemic treatment.MethodsData of 64 patients with recurrent glioblastoma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. PNI was calculated as: [(10 × serum albumin (g/dL)) + (0.005 × total lymphocyte count)]. Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes.ResultsMedian value of PNI was 45.7, and median follow-up duration was 9 months (1–68 months). Median overall survival (OS) was 7.9 months (95%CI: 5.5–10.4). Median OS was significantly longer in patients with PNI > 45.7 compared to patients with PNI ≤ 45.7 (13.9 months (95%CI: 10.5–17.4), and 4.6 months (95%CI: 2.5–6.8), p < 0.001, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS [HR:0.41 (95%CI:0.22–0.74), p = 0.03)].ConclusionIn our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent glioblastoma, but further prospective trials are necessary to validate its prognostic role.