Biodegradable fixation systems could reduce or eliminate problems associated with titanium removal of implants in a second operation.
The aim of this study was to compare the long-term (i.e. >5 years ...postoperatively) clinical performance of a titanium and a biodegradable system in oral and maxillofacial surgery.
The present multicenter Randomized Controlled Trial (RCT) was performed in four hospitals in the Netherlands. Patients treated with a bilateral sagittal split osteotomy (BSSO) and/or a Le Fort-I osteotomy, and those treated for fractures of the mandible, maxilla, or zygoma were included from December 2006 to July 2009. The patients were randomly assigned to either a titanium (KLS Martin) or a biodegradable group (Inion CPS).
After >5 years postoperatively, plate removal was performed in 22 of the 134 (16.4%) patients treated with titanium and in 23 of the 87 (26.4%) patients treated with the biodegradable system (P = 0.036, hazard ratio (HR) biodegradable (95% CI) = 2.0 (1.05-3.8), HR titanium = 1). Occlusion, VAS pain scores, and MFIQ showed good and (almost) pain free mandibular function in both groups.
In conclusion, the performance of the Inion CPS biodegradable system was inferior compared to the KLS Martin titanium system regarding plate/screws removal in the abovementioned surgical procedures.
http://controlled-trials.com ISRCTN44212338.
Abstract The goal of orbital reconstruction is to repair trauma defects, to correct the position of the eye anatomically, avoiding enophthalmos, and to restore ocular function. For the reconstruction ...of (trauma) defects, many surgeons recommend materials that can be bent into an anatomical shape and that possess the properties of radiopacity and long-term stability. However, apart from these desired properties, the ideal material for orbital reconstruction remains controversial. Autologous bone is often mentioned as the ‘gold standard,’ likely because of its mechanical properties, revascularization potential, and its adaptation to the orbital tissue with minimal acute and chronic immune reactivity. However, autologous bone can show unpredictable resorption rates and suboptimal volume correction. In recent years, an increasing interest in the use of alloplasts for orbital reconstruction has become apparent in the literature. Modern technological advantages, such as preoperative planning, navigation, and perioperative imaging, can be beneficial in the decision to choose a certain implant. The aim of this review is to give a comprehensive overview of the advantages and disadvantages of materials used to reconstruct traumatic orbital defects and to provide a practical, evidence-based, complexity-driven set of guidelines.
Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs.
The aim of the present study was ...to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery.
This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS). Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER) were bone healing (8 weeks) and plate removal (2 years).
In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-)analysis and a Treatment-Received (TR-) analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group.
The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO's, Le Fort-I osteotomies and bimaxillary osteotomies.
Controlled-Trials.com ISRCTN 44212338.
Prescription opioid use has increased steadily in many Western countries over the past two decades, most notably in the US, Canada, and most European countries, including the Netherlands. Especially ...the increasing use of prescription opioids for chronic non-cancer pain has raised concerns. Most opioids in the Netherlands are prescribed in general practices. However, little is known about variation in opioid prescribing between general practices. To better understand this, we investigated practice variation in opioid prescribing for non-cancer pain between Dutch general practices.
Data from 2017-2019 of approximately 10% of all Dutch general practices was used. Each year included approximately 1000000 patients distributed over approximately 380 practices. The primary outcome was the proportion of patients with chronic (>90 days) high-dose (≥90 oral morphine equivalents) opioid prescriptions. The secondary outcome was the proportion of patients with chronic (<90 oral morphine equivalents) opioid prescriptions. Practice variation was expressed as the ratio of the 95th/5th percentiles and the ratio of mean top 10/bottom 10. Funnel plots were used to identify outliers. Potential factors associated with unwarranted variation were investigated by comparing outliers on practice size, patient neighbourhood socioeconomic status, and urbanicity.
Results were similar across all years. The magnitude of variation for chronic high-dose opioid prescriptions in 2019 was 7.51-fold (95%/5% ratio), and 15.1-fold (top 10/bottom 10 ratio). The percentage of outliers in the funnel plots varied between 13.8% and 21.7%. Practices with high chronic high-dose opioid prescription proportions were larger, and had more patients from lower income and densely populated areas.
There might be unwarranted practice variation in chronic high-dose opioid prescriptions in primary care, pointing at possible inappropriate use of opioids. This appears to be related to socioeconomic status, urbanicity, and practice size. Further investigation of the factors driving practice variation can provide target points for quality improvement and reduce inappropriate care and unwarranted variation.
Highlights • 14% of 6620 colon cancer patients started adjuvant chemotherapy >8 weeks. • Elderly patients were more likely to start chemotherapy >8 weeks post-surgery. • Various treatment factors ...were associated with starting chemotherapy >8 weeks. • Starting adjuvant chemotherapy >8 weeks was associated with decreased survival. • Starting adjuvant chemotherapy 5–8 versus <4 weeks showed no difference in survival.
Context. High-contrast imaging (HCI) observations of exoplanets can be limited by the island effect (IE). The IE occurs when the main wavefront sensor (WFS) cannot measure sharp phase discontinuities ...across the telescope’s secondary mirror support structures (also known as spiders). On the current generation of telescopes, the IE becomes a severe problem when the ground wind speed is below a few meters per second. During these conditions, the air that is in close contact with the spiders cools down and is not blown away. This can create a sharp optical path length difference between light passing on opposite sides of the spiders. Such an IE aberration is not measured by the WFS and is therefore left uncorrected. This is referred to as the low-wind effect (LWE). The LWE severely distorts the point spread function (PSF), significantly lowering the Strehl ratio and degrading the contrast. Aims. In this article, we aim to show that the focal-plane wavefront sensing (FPWFS) algorithm, Fast and Furious (F&F), can be used to measure and correct the IE/LWE. The F&F algorithm is a sequential phase diversity algorithm and a software-only solution to FPWFS that only requires access to images of non-coronagraphic PSFs and control of the deformable mirror. Methods. We deployed the algorithm on the SCExAO HCI instrument at the Subaru Telescope using the internal near-infrared camera in H -band. We tested with the internal source to verify that F&F can correct a wide variety of LWE phase screens. Subsequently, F&F was deployed on-sky to test its performance with the full end-to-end system and atmospheric turbulence. The performance of the algorithm was evaluated by two metrics based on the PSF quality: (1) the Strehl ratio approximation (SRA), and (2) variance of the normalized first Airy ring (VAR). The VAR measures the distortion of the first Airy ring, and is used to quantify PSF improvements that do not or barely affect the PSF core (e.g., during challenging atmospheric conditions). Results. The internal source results show that F&F can correct a wide range of LWE phase screens. Random LWE phase screens with a peak-to-valley wavefront error between 0.4 μ m and 2 μ m were all corrected to a SRA > 90% and an VAR ⪅ 0.05. Furthermore, the on-sky results show that F&F is able to improve the PSF quality during very challenging atmospheric conditions (1.3–1.4″seeing at 500 nm). Closed-loop tests show that F&F is able to improve the VAR from 0.27–0.03 and therefore significantly improve the symmetry of the PSF. Simultaneous observations of the PSF in the optical ( λ = 750 nm, Δ λ = 50 nm) show that during these tests we were correcting aberrations common to the optical and NIR paths within SCExAO. We could not conclusively determine if we were correcting the LWE and/or (quasi-)static aberrations upstream of SCExAO. Conclusions. The F&F algorithm is a promising focal-plane wavefront sensing technique that has now been successfully tested on-sky. Going forward, the algorithm is suitable for incorporation into observing modes, which will enable PSFs of higher quality and stability during science observations.
Keratinocytes contribute to cutaneous immune responses through the expression of cytokines. We investigated whether human keratinocytes can express IL-23, a newly defined IFN-gamma-inducing cytokine ...composed of a unique p19 subunit and a p40 subunit shared with IL-12. Cultured keratinocytes from normal and lesional psoriatic skin were found to express constitutively mRNA for both subunits of IL-23. Low but significant levels of the heterodimeric IL-23 protein could be detected in cell lysates and supernatants from stimulated keratinocytes by immunoblotting and ELISA. Functional analysis showed that these low levels of keratinocyte-derived IL-23 were sufficient to enhance the IFN-gamma production by memory T cells. Immunostaining of skin sections confirmed expression of both subunits of IL-23 by keratinocytes in situ and also revealed expression of this cytokine in the dermal compartment. IL-23 expression was significantly higher in psoriatic lesional skin, compared with normal and psoriatic nonlesional skin. The immunostained preparations of cultured cells and IL-23 levels in culture supernatants did not show any difference between normal and psoriatic keratinocytes indicating no intrinsic aberration of IL-23 expression in keratinocytes from psoriatic skin. Double staining of cytospin preparations demonstrated that IL-23 p19 is also expressed by epidermal Langerhans cells, dermal dendritic cells, and macrophages. Psoriasis is a chronic inflammatory skin disease mediated by IFN-gamma-expressing type 1 memory T cells. As IL-23 is important to activate memory T cells to produce IFN-gamma, its augmented expression of IL-23 by keratinocytes and cutaneous APC may contribute to the perpetuation of the inflammation process in this disease.
Mesenchymal stem cells (MSCs) represent a promising biological therapeutic option as an osteoarthritis (OA)-modifying treatment. MSCs secrete factors that can counteract inflammatory and catabolic ...processes and attract endogenous repair cells. The effects of intra-articular injection of MSC secretome on OA-related pain, cartilage damage, subchondral bone alterations and synovial inflammation were studied in a mouse collagenase-induced OA model. The MSC secretome was generated by stimulating human bone-marrow-derived MSCs with interferon gamma (IFNγ) and tumour necrosis factor alpha (TNFα). 54 mice were randomly assigned to injections with i) MSC secretome from 20,000 MSCs, ii) 20,000 MSCs or iii) medium (control). Pain was assessed by hind limb weight distribution. Cartilage damage, subchondral bone volume and synovial inflammation were evaluated by histology. MSC-secretome- and MSC-injected mice showed pain reduction at day 7 when compared to control mice. Cartilage damage was more abundant in the control group as compared to healthy knees, a difference which was not found in knees treated with MSC secretome or MSCs. No effects were observed regarding synovial inflammation, subchondral bone volume or the presence of different macrophage subtypes. Injection of MSC secretome, similarly to injection of MSCs, resulted in early pain reduction and had a protective effect on the development of cartilage damage in a murine OA model. By using the regenerative capacities of the MSC-secreted factors, it will be possible to greatly enhance the standardisation, affordability and clinical translatability of the approach. This way, this biological therapy could evolve towards a true disease-modifying anti-osteoarthritic drug.
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