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Traumatic brain injury (TBI) is a major cause of death and disability worldwide. There are no effective therapies available for TBI patients. Vepoloxamer is an amphiphilic polyethylene-polypropylene-polyethylene tri-block copolymer that seals membranes and restores plasma membrane integrity in damaged cells. We previously demonstrated that treatment of TBI rats with Vepoloxamer improves functional recovery. However, additional studies are needed to potentially translate Vepoloxamer treatment from preclinical studies into clinical applications. We thus conducted a study to investigate dose-response and therapeutic window of Vepoloxamer on functional recovery of adult rats after TBI. To identify the most effective dose of Vepoloxamer, male Wistar adult rats with controlled cortical impact (CCI) injury were randomly treated with 0 (vehicle), 100, 300, or 600 mg/kg of Vepoloxamer, administered intravenously (IV) at 2 h after TBI. We then performed a therapeutic window study in which the rats were treated IV with the most effective single dose of Vepoloxamer at different time points of 2 h, 4 h, 1 day, or 3 days after TBI. A battery of cognitive and neurological tests was performed. Animals were killed 35 days after TBI for histopathological analysis. Dose-response experiments showed that Vepoloxamer at all three tested doses (100, 300, 600 mg/kg) administered 2 h post injury significantly improved cognitive functional recovery, whereas Vepoloxamer at doses of 300 and 600 mg/kg, but not the 100 mg/kg dose, significantly reduced lesion volume compared to saline treatment. However, Vepoloxamer at 300 mg/kg showed significantly improved neurological and cognitive outcomes than treatment with a dose of 600 mg/kg. In addition, our data demonstrated that the dose of 300 mg/kg of Vepoloxamer administered at 2 h, 4 h, 1 day, or 3 days post injury significantly improved neurological function compared with vehicle, whereas Vepoloxamer administered at 2 h or 4 h post injury significantly improved cognitive function compared with the 1-day and 3-day treatments, with the most robust effect administered at 2 h post injury. The present study demonstrated that Vepoloxamer improves functional recovery in a dose-and time-dependent manner, with therapeutic efficacy compared with vehicle evident even when the treatment is initiated 3 days post TBI in the rat., Competing Interests: Declaration of competing interest Marty Emanuele was an employee of LifeRaft Technologies, Inc., San Diego, CA. and currently he is an employee of Visgenx, Inc., Santa Cruz, CA. For the other authors, no competing financial interests exist., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Ultrahigh molecular weight polyethylene (UHMWPE) is widely used in total joint arthroplasties as a load-bearing surface. Periprosthetic joint infections, the majority of which occur shortly after joint replacement, constitute almost 25% of total knee revision surgeries, and the complete eradication of bacterial infection poses a major challenge. A promising way to tackle this problem is to ensure the local sustained delivery of antibiotic concentrations sufficient to inhibit the bacteria to support routine systemic antibiotic prophylaxis. There is increased research into the development of efficient local drug delivery devices. Although established antibacterial testing methods for drugs can be used to test the antibacterial efficacy of drug-eluting materials, they are lacking in terms of providing real-time and longitudinal antibacterial efficacy data that can be correlated to the elution profiles of antibiotics from these devices. Here, we report a direct and versatile methodology to determine the antibacterial efficacy of antibiotic-eluting UHMWPE implants. This methodology can be used as a platform to avoid bacterial culture at each time point of a lengthy experiment and can also be adapted to other local drug delivery devices.

Since autologous split-thickness skin grafts are scarce and lab skin growth requires a significant amount of time, there are limited available treatment approaches for patients with full-thickness burns greater than 90% TBSA. Additionally, to achieve the primary goal of skin coverage and resuscitation, there must exist a balance between fluid loss and metabolic derangement. Allografts and xenografts have traditionally been used early in the process to achieve these goals. Currently, novel approaches to treatment consider the additional use of synthetic dermal substitutes and autologous skin cell suspension to improve outcomes. This case series describes the treatment course of patients with greater than 90% TBSA full-thickness burn injuries using a staged, multifaceted approach of using NovoSorb Biodegradable Temporizing Matrix™ as the primary dermal substitute in conjunction with a RECELL™ Autologous Cell Suspensions Device applied with autograft and allograft to achieve improved resuscitation, limiting fluid loss, and finally skin coverage. Allograft and NovoSorb Biodegradable Temporizing Matrix™ were used early to cover excised burns, resulting in improved metabolic control by limiting the systemic inflammatory response syndrome and fluid loss. Both patients survived using this approach., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives /hypothesis: Empty nose syndrome (ENS) is a complicated condition currently thought to be caused by excessive surgical resection of turbinate tissue. Patients with ENS experienced significant psychological symptoms, such as depression and anxiety. This study aimed to evaluate the impact of the psychological burden on the surgical outcome of ENS., Study Design: Prospective case series in a tertiary medical center., Methods: Patients with ENS were prospectively recruited between 2015 and 2018. Validated instruments including the Sinonasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were used to evaluate patients with ENS prior to and 3, 6, and 12 months after nasal reconstruction surgery with submucosal Medpor implantation., Results: A total of 54 ENS patients were enrolled during the study period. All three evaluations revealed significant improvement, and symptoms stabilized 3 months after surgery. Six months post-operatively, SNOT-25 scores were significantly associated with the pre-operative BDI-II and BAI scores (β = 0.64 and 0.87; P = .006 and <.001, respectively). Multivariate regression model revealed that only BAI scores were significantly associated with the six-month post-operative SNOT-25 scores (adjusted β = 0.49, P = .036). Moreover, Spearman's correlation found close relationships between the post-operative SNOT-25 and the post-operative BDI-II and BAI scores (r s = 0.751 and 0.884, both P < .001)., Conclusions: Psychological evaluation can help predict surgical outcomes and identify patients with residual disease. These findings emphasize the importance of screening for psychological symptoms and structuring care by including psychological therapy in addition to surgery., Level of Evidence: 4. Laryngoscope, 131:E694-E701, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Periprosthetic joint infection (PJI) is one of the main causes for the failure of joint arthroplasty. In view of the limited clinical effect of oral/injectable antibiotics and the drug resistance problem, there is a pressing need to develop antibacterial implants with therapeutic antimicrobial properties. In this work, we prepared a highly antibacterial ultrahigh molecular weight polyethylene (UHMWPE) implant by incorporating tea polyphenols. The presence of tea polyphenols not only improved the oxidation stability of irradiated UHMWPE, but also gave it the desirable antibacterial property. The potent antibacterial activity was attributed to the tea polyphenols that produced excess intracellular reactive oxygen species and destroyed the bacterial membrane structure. The tea polyphenol-blended UHMWPE had no biological toxicity to human adipose-derived stem cells and effectively reduced bacteria-induced inflammation in vivo. These results indicate that tea polyphenol-blended UHMWPE is promising for joint replacement prostheses with multifunctionality to meet patient satisfaction.

Background: The efficacy of negative pressure wound therapy (NPWT) in the acute management of burns remains unclear. The purpose of this trial was to compare standard Acticoat™ and Mepitel™ dressings with combined Acticoat™, Mepitel™ and continuous NPWT to determine the effect of adjunctive NPWT on re-epithelialization in paediatric burns., Methods: This two-arm, single-centre RCT recruited children with acute thermal burns covering less than 5 per cent of their total body surface area. The primary outcome was time to re-epithelialization. Blinded assessments were performed using photographs captured every 3-5 days until discharge. Secondary measures included pain, itch, grafting, perfusion and scar management referrals., Results: Some 114 patients were randomized. Median time to re-epithelialization was 8 (i.q.r. 7-11) days in the NPWT group and 10 (8-14) days in the control group. In a multivariable model, NPWT decreased the expected time to wound closure by 22 (95 per cent c.i. 7 to 34) per cent (P = 0·005). The risk of referral to scar management was reduced by 60 (18 to 81) per cent (P = 0·013). Four participants in the control group and one in the NPWT group underwent grafting. There were no statistically significant differences between groups in pain, itch or laser Doppler measures of perfusion. Adverse events were rare and minor, although NPWT carried a moderate treatment burden, with ten patients discontinuing early., Conclusion: Adjunctive NPWT hastened re-epithelialization in small-area burn injuries in children, but had a greater treatment burden than standard dressings alone. Registration number: ACTRN12618000256279 ( http://ANZCTR.org.au)., (© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)

Background and purpose - The long-term survival of arthroplasty components may be limited by polyethylene wear-related problems such as periprosthetic osteolysis and aseptic loosening. Highly cross-linked polyethylene (HXLPE) blended with vitamin E was introduced to improve oxidative stability and to avoid long-term embrittlement. This study clinically compares the tribological behavior and clinical outcome of vitamin E blended HXLPE with ultra-high molecular weight polyethylene (UHMWPE) in an isoelastic monoblock cup for uncemented total hip arthroplasty. Patients and methods - In this randomized controlled trial (RCT), 199 patients were included: 102 patients received the vitamin E blended HXLPE cup, 97 patients the UHMWPE cup. Clinical and radiographic parameters were obtained preoperatively, directly postoperative and at 3, 12, and 24 months. Wear rates were compared using the mean linear femoral head penetration (FHP) rate. Results - 188 patients (94%) completed the 2-year follow-up. Mean patient satisfaction was higher in the vitamin E blended HXLPE group (8.9 [1]) than in in the control group (8.5 [2], p = 0.03). The Harris Hip Score (HHS) was higher in the vitamin E blended HXLPE group (95 [8]) than in the control group (92 [11], p = 0.3). The FHP rate was lower in the vitamin E blended HXLPE group: 0.046 mm/year compared with 0.056 mm/year in the control group (p = 0.05). No adverse reactions associated with the clinical application of vitamin E blended HXLPE were observed during follow-up, with an excellent 2-year survival to revision rate of 98% for both cups. Interpretation - This study shows the superior performance of the HXLPE blended with vitamin E acetabular cup with lower linear femoral head penetration rates and better clinical results compared with the UHMWPE acetabular cup after 2 years.

We report here for the first time how the combination of a precursor solution and low temperature (170 °C) aerosol assisted chemical vapour deposition were used to bond a copper coating to ultra-high molecular weight polyethylene (UHMWPE) and promote robustness. This metallic thin film remained intact on the UHMWPE substrate after the Scotch tape test and showed notable wear-resistance after 10 cycles of sand paper-abrasion. Antimicrobial assays against both Escherichia coli and Staphylococcus aureus revealed potent dark bactericidal activity with 99.999% reduction in bacterial number within 15 minutes. These results suggest that the modified UHMWPE could be a potential candidate for antimicrobial plastics and in the long term may find application in prosthetic joint applications.

Unlike other oral care products, there are limited technologies in the denture adhesive category with the majority based on polymethyl vinyl ether/maleic anhydride (PVM/MA) polymer. Carbomer-based denture adhesives are less well studied, and there are few clinical studies directly comparing performance of denture adhesives based on different technologies. This single-centre, randomised, three-treatment, three-period, examiner-blind, crossover study compared a carbomer-based denture adhesive (Test adhesive) with a PVM/MA-based adhesive (Reference adhesive) and no adhesive using incisal bite force measurements (area over baseline over 12 hr; AOB 0-12 ) in participants with a well-made and at least moderately well-fitting complete maxillary denture. Eligible participants were randomised to a treatment sequence and bit on a force transducer with increasing force until their maxillary denture dislodged. This procedure was performed prior to treatment application (baseline) and at 0.5, 1, 3, 6, 9, and 12 hr following application. Forty-four participants were included in the modified intent-to-treat population. AOB 0-12 favoured both Test adhesive to No adhesive (difference: 2.12 lbs; 95% CI [1.25, 3.00]; p  < 0.0001) and Reference adhesive to No adhesive (difference: 2.76 lbs; 95% CI [1.89, 3.63]; p  < 0.0001). There was a numerical difference in AOB 0-12 for Test versus Reference adhesive (-0.63 lbs; [-1.51, 0.25]); however, this was not statistically significant ( p  = 0.1555). Treatments were generally well tolerated. Both PVM/MA and carbomer-based denture adhesives demonstrated statistically significantly superior denture retention compared with no adhesive over 12 hr, with no statistically significant difference between adhesives.

Objective: The aim of this study is to evaluate the effects of different fiber insertion techniques and thermomechanical aging on the fracture resistance of endodontically treated mandibular premolar teeth restored using bulk-fill composites., Materials and Methods: Eighty human mandibular premolar teeth were randomly divided into eight groups: Group IN, Group BF, Group PRF1, Group PRF2, Group IN-TMA, Group BF-TMA, Group PRF1-TMA ,and Group PRF2-TMA. Group IN (intact) and Group IN-TMA (intact but subjected to thermomechanical aging) served as control groups. In the other six groups, endodontic treatment was performed and standardized mesio-occluso-distal (MOD) cavities were prepared. In BF, PRF1, and PRF2, the cavities were restored with bulk-fill composite only, bulk-fill/Ribbond, and bulk-fill/additional Ribbond, respectively. In BF-TMA, PRF1-TMA, and PRF2-TMA, the teeth were subjected to thermomechanical aging after the restorations. All of the teeth were fractured on the universal testing machine. Fracture surfaces were analyzed with a stereomicroscope., Results: Control groups showed significantly higher fracture strengths than tested groups ( P <0.05). No statistically significant difference was observed among the tested groups ( P >0.05). Most of the favorable fractures were seen in PRF1, PRF2, and PRF2-TMA. Most of the unfavorable fractures were seen in BF-TMA., Conclusions: Although fiber insertion with different techniques did not increase the fracture strength of teeth restored with bulk-fill composites, it increased the favorable fracture modes. Thermomechanical aging did not change the fracture strength of the groups.

Background: Polyethylene (Medpor) and silicone are two of the most popular materials used today for facial skeleton implantation. Previous studies have identified common complications with the use of these implants, but patient follow-up has been short. This review of the literature examines complications and patient follow-up in cases using Medpor and silicone implants for reconstructive and aesthetic operations of the mid and lower face over the past 20 years., Methods: A literature search was conducted through the PubMed database. Keywords used were as follows: ("mandible implants" or "malar implants" or "chin implants") AND ("reconstruction" or "augmentation") AND ("Medpor" or "silicone")., Results: There were nine studies with 626 patients in the Medpor group and five studies with 365 patients in the silicone group. The silicone group had a higher incidence of infections and displacements. The Medpor group showed a higher incidence of prominence problems. Exposure/extrusion rates were low for both implant types. Chin and mandibular implants were the safest, whereas malar implants had a high incidence of prominence problems. The average follow-up for Medpor was 36.6 months and 24 months for silicone. There were wide ranges of follow-up times, from 2 weeks up to 15 years. A limited number of articles included an averaged time within their ranges. Reported follow-up times were not linked to specific complications., Conclusions: Medpor implantation is more common than silicone. Complication rates are low with the use of both materials. Patient follow-up is deficient and has not improved in the past 20 years, raising questions on the reliability of complication rates.

Targeted delivery of drug molecules to specific cells in mammalian systems demonstrates a great potential to enhance the efficacy of current pharmaceutical therapies. Conventional strategies for pharmaceutical delivery are often associated with poor therapeutic indices and high systemic cytotoxicity, and this result in poor disease suppression, low surviving rates, and potential contraindication of drug formulation. The emergence of aptamers has elicited new research interests into enhanced targeted drug delivery due to their unique characteristics as targeting elements. Aptamers can be engineered to bind to their cognate cellular targets with high affinity and specificity, and this is important to navigate active drug molecules and deliver sufficient dosage to targeted malignant cells. However, the targeting performance of aptamers can be impacted by several factors including endonuclease-mediated degradation, rapid renal filtration, biochemical complexation, and cell membrane electrostatic repulsion. This has subsequently led to the development of smart aptamer-immobilized biopolymer systems as delivery vehicles for controlled and sustained drug release to specific cells at effective therapeutic dosage and minimal systemic cytotoxicity. This article reports the synthesis and in vitro characterization of a novel multi-layer co-polymeric targeted drug delivery system based on drug-loaded PLGA-Aptamer-PEI (DPAP) formulation with a stage-wise delivery mechanism. A thrombin-specific DNA aptamer was used to develop the DPAP system while Bovine Serum Albumin (BSA) was used as a biopharmaceutical drug in the synthesis process by ultrasonication. Biophysical characterization of the DPAP system showed a spherical shaped particulate formulation with a unimodal particle size distribution of average size ∼0.685 µm and a zeta potential of +0.82 mV. The DPAP formulation showed a high encapsulation efficiency of 89.4 ± 3.6%, a loading capacity of 17.89 ± 0.72 mg BSA protein/100 mg PLGA polymeric particles, low cytotoxicity and a controlled drug release characteristics in 43 days. The results demonstrate a great promise in the development of DPAP formulation for enhanced in vivo cell targeting. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 34:249-261, 2018., (© 2017 American Institute of Chemical Engineers.)

Objective: Understanding the biomechanical properties of hernia meshes is essential in facilitating their selection. The aim of this study was to evaluate the mechanical compatibility of hernia meshes and human abdominal fascia and assess their applicability in hernia repair., Methods: Uniaxial tensile tests were performed. A total of eight hernia meshes were tested - three standard meshes (Surgimesh®, Surgipro™, TecnoMesh®) and five light-weight meshes (Optilene®, TiO2Mesh™, Parietex™, Vypro™ II, Ultrapro™)., Results: The secant modulus at 5% strain and the level of orthotropy (the ratio between tensile stress in the longitudinal and the transversal direction) at 5% strain were calculated from the stress-stretch ratio curves. The impact of pore size and thickness on the elastic properties of these meshes was determined. The relationships between density and elasticity as well as between elasticity and the strain developed at 16 N/cm load were presented. The resulting mechanical properties of meshes were compared to the elasticity, orthotropy and deformability of human abdominal fascia., Conclusions: Vypro™ II and Parietex™ brands display properties similar to those of fascia in both directions. The TiO2Mesh™ and Ultrapro™ display deformability close to the deformability at 16 N/cm of the fascia transversalis. Only the Vypro™ II brand's orthotropy is similar to that of fascia.

Endoscopic endonasal resection of orbital lesions is a safe and common approach. Nevertheless, medial orbital wall defects following the procedure are not routinely addressed, potentially leading to diplopia and enophthalmos. In this article, the authors propose a new technique for purely endoscopic endonasal reconstruction of orbital wall defects following endoscopic endonasal resection of orbital lesions.The patient, a 43-year-old male, suffering from right exophthalmos and diplopia due to a venous malformation of the right orbit underwent endoscopic endonasal resection of the mass. Excision was followed by immediate transnasal endoscopic reconstruction with a commercially available porous polyethylene mesh (Medpor).The postoperative course was uneventful. The patient did not report any residual orbital asymmetry or diplopia. No recurrence of the venous malformation, mesh infection, or reconstruction instability was reported during the follow-up.The authors believe that this new technique could spur head and neck surgeons in strategically rethinking their approach to orbital tumors, proposing reconstruction to patients on a routine basis, and developing even more reliable and manageable solutions.

With the development of three-dimensional Raman algorithms for local mapping of oxidation and plastic strain, and the ability to resolve molecular orientation patterns with microscopic spatial resolution, there is an opportunity to re-examine many of the foundations on which our understanding of biomedical grade ultra-high molecular weight polyethylenes (UHMWPEs) are based. By implementing polarized Raman spectroscopy into an automatized tool with an improved precision in non-destructively resolving Euler angles, oxidation levels, and microscopic strain, we become capable to make accurate and traceable measurements of the in vitro and in vivo tribological responses of a variety of commercially available UHMWPE bearings for artificial hip and knee joints. In this paper, we first review the foundations and the main algorithms for Raman analyses of oxidation and strain of biomedical polyethylene. Then, we critically re-examine a large body of Raman data previously collected on different polyethylene joint components after in vitro testing or in vivo service, in order to shed new light on an area of particular importance to joint orthopedics: the microscopic nature of UHMWPE surface degradation in the human body. A complex scenario of physical chemistry appears from the Raman analyses, which highlights the importance of molecular-scale phenomena besides mere microstructural changes. The availability of the Raman microscopic probe for visualizing oxidation patterns unveiled striking findings related to the chemical contribution to wear degradation: chain-breaking and subsequent formation of carboxylic acid sites preferentially occur in correspondence of third-phase regions, and they are triggered by emission of dehydroxylated oxygen from ceramic oxide counterparts. These findings profoundly differ from more popular (and simplistic) notions of mechanistic tribology adopted in analyzing joint simulator data. Statement of Significance This review was dedicated to the theoretical and experimental evaluation of the commercially available biomedical polyethylene samples by Raman spectroscopy with regard to their molecular textures, oxidative patterns, and plastic strain at the microscopic level in the three dimensions of the Euclidean space. The main achievements could be listed, as follow: (i) visualization of molecular patterns at the surface of UHMWPE bearings operating against metallic components; (ii) differentiation between wear and creep deformation in retrievals; (iii) non-destructive mapping of oxidative patterns; and, (iv) the clarification of chemical interactions between oxide/non-oxide ceramic heads and advanced UHMWPE liners., (Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate the application of MEDPOR surgical implant in modified penile elongation., Methods: The suspensory ligaments were divided, and cavernous bodies of crus were partially mobilized, so as to release part of the cavernous bodies from inferior ramus of pubis. Then, the penis was elongated sufficiently. MEDPOR surgical implants (MEDPOR; high-density porous polyethylene, Howmedica Osteonics Corp. Newnan, Ga) were inserted between the cavernous bodies and pubic symphysis. Local fat flap was transposed to fill the front space of pubis to make sure of the effective elongation of penis and improve the appearance of mons pubis., Results: Nineteen cases of micropenis were treated. The average length of the penis was 5.23 cm in the static state and 7.83 cm in erectile state before operation. After the operation, it increased to 8.63 cm in the static state and 11.36 cm in erectile state., Conclusions: Application for MEDPOR surgical implant in modified penile elongation can make sure of the effective elongation of penis and improve the appearance of mons pubis.

Purpose: Dual mobility cup (DMC) consists of a cobalt-chromium (CoCr) alloy cup articulated with a polyethylene (PE) mobile component capturing the femoral head in force using a snap-fit technique. This biomechanical study was the first to evaluate and compare the generation of cracks in the retentive area of DMC mobile components made of highly crosslinked PE (XLPE) or conventional ultra-high molecular weight PE (UHMWPE)., Methods: Eighty mobile components designed for a 52-mm diameter Symbol® DMC (Dedienne Santé, Mauguio, France) and a 28-mm diameter femoral head were analyzed. Four groups of 20 mobile components were constituted according to the PE material: raw UHMWPE, sterilized UHMWPE, annealed XLPE and remelted XLPE. Ten mobile components in each group were impacted with a 28-mm diameter CoCr femoral head using a snap-fit technique. The occurrence, location and area of the cracks in the retentive area were investigated using micro-CT (Skyscan 1176®, Bruker, Aarsellar, Belgium) with a 35 μm nominal isotropic voxel size by two observers blinded to the PE material and impaction or not of the mobile components., Results: Compared to conventional UHMWPE, the femoral head snap-fit did not generate more or wider cracks in the retentive area of annealed or remelted XLPE mobile components., Conclusion: This biomechanical study suggests that XLPE in DMC could be a safe alternative to conventional UHMWPE regarding the generation of cracks in the retentive area related to the femoral head snap-fit.

Among the bearing surfaces involved in a total hip arthroplasty, ultra-high molecular weight polyethylene (UHMWPE) is the weak link. It is submitted to the friction of a harder bearing, producing wear particles, which, in turn, initiate an inflammatory reaction ultimately leading to osteolysis. This kind of bone deterioration sometimes turns out to an aggressive granuloma and may provoke implant loosening. Wear resistance of UHMWPE depends on its molecular weight and crystallinity. Some steps of the manufacturing process were improved to optimize its tribological properties and to slow down degradation resulting from mechanical (abrasion) and chemical (oxidation) phenomena. Its preparation and conservation must be performed in an inert atmosphere, i.e. without ambient oxygen. Its resistance to abrasion depends on its cross-linking degree. Its cross-linking rate was observed to increase proportionally to the irradiation doses, improving its wear resistance. However, its mechanical properties are impaired and moreover, it becomes oxidation sensitive. It is therefore necessary to submit it to a thermal treatment to eliminate free radicals that were produced during irradiation. More recently impregnation by vitamin E, a powerful anti-oxidant product, was proposed to preserve the polymer from in vivo oxidation while maintaining its mechanical properties. We raised the hypothesis that last-generation UHMWPE could offer the same wear resistance as the most performing bearings (ceramic-on-ceramic). Recent clinical results confirm the tribological performance of highly crosslinked UHMWPE in vivo. However, it remains to be seen whether this excellent wear resistance would persist under eccentric load such as edge loading, and if, in the long run, this kind of bearing proves capable of reducing the risk of osteolysis in young and active patients., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: The diffuse epidermal exfoliation seen in Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is similar to skin loss in second degree burns, and many of these patients are referred for treatment at burn centers. Treatment can differ markedly from center to center, and mortality can range from 25% to 70%, including a considerable morbidity. However, our experience over a 15-year period from 2000 to 2015 with 40 patients found a mortality rate of only 10% (4/40). The purpose of this paper is to discuss our treatment algorithm as a model for other centers treating SJS/TENs patients., Methods: Records were reviewed for all patients admitted to the LAC+USC burn unit between 2000 and 2015 and 40 patients were identified with biopsy-proven SJS or TENS. These cases were reviewed for age, gender, initial and greatest TBSA, causative drug, pre-existing medical conditions, and morbidity and mortality. All data were entered into the SPSS statistical software package and all statistical analyses were performed using this program., Results: Our treatment algorithm focused on early referral to a specialty burn unit, immediate discontinuation of the offending drug, fluid resuscitation, nutritional supplementation, and meticulous wound care. Average time to transfer to a burn unit was 3.36 days. Silver-releasing antimicrobial dressings were applied to the affected skin surface and changed every 3 days. Mupirocin coated petroleum gauze was used for facial involvement. Steroids were tapered and discontinued if initiated at an outside facility (58% of patients), and starting after 2001, all patients received a course of IVIG. All patients received fluid resuscitation and the majority received supplemental tube feedings (69%). Average length of total stay was 17.1 days and length of ICU stay 15.9 days. While 44% were transferred to another facility for further rehabilitative care, 37% of patients discharge to home. In patients discharged home with complete resolution of skin lesions, time to healing was an average of 14 days., Discussion: With our 10% mortality rate in 40 patients, our study represents a relatively large study population while maintaining a relatively low mortality rate. The demographic data from our study largely aligns with the existing literature, and we therefore feel that our low mortality rate is due to our treatment algorithm, rather than to a less severe pathology in our patient population. This claim is supported by a standard mortality ratio of 1.68. This ratio proves a significantly improved mortality than would be expected based on disease severity on admission., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To compare the wear of conventional ultra-high molecular weight polyethylene (CUHMWPE) and highly cross-linked polyethylene (HCLPE) in hip revision with liner exchange fixed with original locking mechanism using analysis of history medical data., Methods: From Jan. 1, 2000, to Dec. 31, 2007, 26 patients (with 29 involved hips) underwent liner exchange revision fixed with the original locking mechanism due to wear of CUHMWPE and/or osteolysis. The mean age was 53 ± 9 years at the time of the primary total hip arthroplasty (THA) and 64 ± 9 years at the revision. The exchanged liners (Marathon, Depuy) were made of HCLPE. Annual X-rays were used to measure linear wear and osteolysis. The annual linear penetration was measured using PolyWare® software (Draftware Inc.). Annual Harris Hip Scores(HSS) were recorded., Results: The mean follow-up time between the primary and revision THAs was 11 ± 2 years and 8 ± 2 years after revision. The mean Harris Hip Score(HHS) before primary THA, 1 year after primary THA, before revision and 1 year after revision was 43±5, 85±5, 71±6, 83±7 individually. The mean penetration of the CUHMWPE and HCLPE liners occurring in the first year were 0.44 ± 0.28 mm and 0.38 ± 0.14 mm, respectively (p = 0.211). The mean annual linear penetration of CUHMWPE and HCLPE from the second year onward were 0.29±0.09 mm and 0.08 ± 0.03 mm respectively (p <0.01). All THAs with CUHMWPE showed osteolysis on acetabular and/or femoral side before revision. No HCLPE liner showed osteolysis at the last follow-up. Conclusion: The CUHMWPE liner had a significantly higher wear rate than did the HCLPE liner. The HCLPE liner showed a satisfactory liner penetration rate after revision with isolated liner exchange fixed with the original locking mechanism., Competing Interests: The authors have declared that no competing interests exist.

Background: Steam vaporizers are used to humidify air in dry environments. They are marketed to moisten children's airway secretions and thus to help relieve symptoms associated with upper respiratory tract infections. Unfortunately the steam emitted from the unit can also pose a significant risk of burns to children. Our study aimed to ascertain patterns of injury and treatment outcomes from steam burns resulting from these devices. Potential preventative measures are discussed., Methods: Children who had sustained vaporizer scald burns were identified at the outpatient burns clinic over a 10-month period (November 2014-August 2015). Medical records were reviewed retrospectively and data collected on pattern of injury, management and outcomes., Results: Ten children were treated for vaporizer steam burns over the study period. The mean age was 1.6 years and 8 (80%) patients were male. Operative intervention was undergone in 5 (50%) cases; four acutely and one as a secondary reconstructive procedure. Hand burns accounted for 8 (80%) of cases., Conclusions: Steam vaporizers can cause significant burns in the paediatric population. Toddlers were most at risk, frequently sustaining hand burns that underwent skin grafting. Greater public awareness of the danger is indicated and measures to prevent such injuries should be addressed by appropriate authorities., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Study Design: An animal study., Objective: To explore ultra-high molecular weight polyethylene (UHMWPE) sublaminar wires in spinal surgery and to assess stability and biocompatibility of the UHMWPE instrumentation in an ovine model., Summary of Background Data: Sublaminar wiring is a well-established technique in segmental scoliosis surgery. However, during introduction and/or removal of the metal sublaminar wires, neurological problems can occur. Abrasion after cutting metal wires for removal can lead to damage to the dural sac. Sublaminar wires have to withhold large forces and breakage of the wires can occur. Different types of sublaminar wires have been developed to address these problems. UHMWPE sublaminar wires can potentially substitute currently used metal sublaminar metal wires. In vivo testing and biocompatibility analysis of UHMWPE wires are recommended before clinical use in spinal surgery., Materials and Methods: In 6 immature sheep, pedicle screws were instrumented at lumbar level L4 and attached with titanium rods to 4 thoracolumbar vertebrae using 3- and 5-mm-wide UHMWPE sublaminar wiring constructions in 5 animals. Titanium sublaminar wires were applied in 1 animal to function as a control subject. After a follow-up period of 16 weeks, the animals were sacrificed and the spines were isolated. Radiographs and computed tomography (CT) scans were made to assess stability of the instrumentation. The vertebrae were dissected for macroscopic and histologic evaluation., Results: None of the wires had loosened and the instrumentation remained stable. CT scans and radiographs showed no signs of failure of the instrumentation and no neurological complications occurred. Although several bony bridges were seen on CT, growth was observed at the operated levels. Biocompatibility was assessed by macroscopical and histologic analysis, showing no signs of dural or epidural inflammation., Conclusions: This pilot animal study shows that UHMWPE sublaminar wiring is a safe technique. The UHMWPE wires are biocompatible and provide sufficient stability in spinal instrumentation. Heterotopic ossification because of periost reactions in the ovine spine led to some restrictions in this study.

Bioimpedance spectroscopy (BIS) is a tool utilized in health care to investigate body composition and fluid distribution. Limited research has addressed the clinical use of BIS in burns. This study aimed to examine the effects of silver dressings on BIS measurements in burns patients. BIS measurements were collected during two dressing conditions: no dressing (ND), and; Acticoat™ dressing (AD). Wilcoxon sign-ranks tests determined if there were any significant differences in BIS measures between the dressing conditions. Multilevel mixed-effects linear regressions examined the effect of %TBSA and body mass on BIS variables across the dressing conditions. The mean age of the patients (n=31) was 34.90 years; with a median TBSA of 15%. There was a significant increase in extracellular fluid (ECF) (p<0.001), intracellular fluid (ICF) (p<0.001) and total body water (TBW) (p<0.001) when AD was in place. There were significant interactions between dressing condition, %TBSA and body mass, whereby the difference in ECF, ICF and TBW between the ND and AD conditions were increased as %TBSA and body mass increased. Algorithms were developed subsequently to adjust BIS outputs for use when AD is in place. Clinician's may continue to use BIS in real-time using the predictive algorithms established during this study., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Study Design: Prospective clinical case series., Objectives: To describe our surgical procedure and results for posterior correction and fusion with a hybrid approach using pedicle screws, hooks, and ultrahigh-molecular weight polyethylene tape with direct vertebral rotation (DVR) (the PSTH-DVR procedure) for treatment of adolescent idiopathic scoliosis (AIS) with satisfactory correction in the coronal and sagittal planes., Summary of Background Data: Introduction of segmental pedicle screws in posterior surgery for AIS has facilitated good correction and fusion. However, procedures using only pedicle screws have risks during screw insertion, higher costs, and decreased postoperative thoracic kyphosis. We have obtained good outcomes compared with segmental pedicle screw fixation in surgery for AIS using a relatively simple operative procedure (PSTH-DVR) that uses fewer pedicle screws., Methods: The subjects were 30 consecutive patients with AIS who underwent the PSTH-DVR procedure and were followed for a minimum of 2 years. Preoperative flexibility, preoperative and postoperative Cobb angles, correction rates, loss of correction, thoracic kyphotic angles (T5-T12), coronal balance, sagittal balance, and shoulder balance were measured on plain radiographs. Rib hump, operation time, estimated blood loss, spinal cord monitoring findings, complications, and scoliosis research society (SRS)-22 scores were also examined., Results: The mean preoperative curve of 58.0 degrees (range, 40-96 degrees) was corrected to a mean of 9.9 degrees postoperatively, and the correction rate was 83.6%. Fusion was obtained in all patients without loss of correction. In 10 cases with preoperative kyphosis angles (T5-T12) <10 degrees, the preoperative mean of 5.8 degrees improved to 20.2 degrees at the final follow-up. Rib hump and coronal, sagittal and shoulder balances were also improved, and good SRS-22 scores were achieved at final follow-up., Conclusions: The correction of deformity with PSTH-DVR is equivalent to that of all-pedicle screw constructs. The procedure gives favorable correction, is advantageous for kyphosis compared with segmental screw fixation, and uses the minimum number of pedicle screws. Therefore, the PSTH-DVR procedure may be useful for treatment of idiopathic scoliosis.

Silver-impregnated dressings are increasingly preferred over silver sulfadiazine cream in the management of pediatric burns. An ideal burns dressing would provide a moist, sterile environment, discourage infection, and not require painful dressing changes. This study sought to determine whether silver sodium carboxymethyl cellulose (Aquacel Ag, ConvaTec, Greensboro, NC) dressing is a superior treatment to nanocrystalline silver-coated polyethylene (Acticoat, Smith & Nephew, London, United Kingdom) dressing in pediatric patients with partial thickness burns. The authors conducted a single-blind, randomized controlled trial in 89 patients presenting to Starship Children's Emergency Department with uncomplicated partial-thickness burns. Patients were randomized to receive either an Acticoat (n = 45) or Aquacel Ag (n = 44) dressing. Photographs of the burn before dressing and at day 10 were assessed by two blinded pediatric burn surgeons to determine the primary outcome and percentage epithelialization. Secondary outcomes were number of dressing changes required and number and type of adverse events. Both treatment groups achieved satisfactory rates of burn healing. There was no difference between groups in the percentage epithelialization at day 10 (Acticoat [mean ± SD] = 93 ± 14%; Aquacel Ag = 94 ± 17%, P = .89). Adverse events such as infection and escalation of care were rare, with no difference detected between groups. Compared with Acticoat, Aquacel Ag dressings required significantly less dressing changes per patient {Acticoat [median (interquartile range)] = 2 (2-2), Aquacel Ag=1 (1-1), P = .03}. Both Acticoat and Aquacel Ag dressings are effective burn dressings, allowing reepithelialization and preventing infection in a subset of uncomplicated partial-thickness burns in pediatric patients. Aquacel Ag requires fewer dressing changes. This decrease in frequency of dressing changes and direct manipulation of the wound, which can be distressing or require additional intervention, identified Aquacel Ag as the superior dressing. The majority of partial thickness pediatric burns heal within 10 days; however, a considerable minority requires the wound to be dressed for a longer period of time and/or specialist intervention. To identify these patients, expert review of the wound at 10 days postburn is recommended.

Periprosthetic osteolysis remains a major limitation of long-term successful total hip replacements with ultra-high molecular weight polyethylene (UHMWPE) bearings. As intra and extracellular reactive oxygen species are know to contribute to wear debris-induced osteoclastic bone resorption and decreased osteoblastic bone formation, antioxidant doped UHMWPE has emerged as an approach to reduce the osteolytic potential of wear debris and maintain coupled bone remodeling. To test this hypothesis in vivo, we evaluated the effects of crosslinked UHMWPE wear debris particles (AltrX(™) ), versus similar wear particles made from COVERNOX(™) containing UHMWPE (AOX(™) ), in an established murine calvaria model. Eight-week-old female C57B/6 mice (n = 10/Group) received a pre-op micro-CT scan prior to surgical implantation of the UHMWPE particles (2mg), or surgery without particles (sham). Dynamic labeling was performed by intraperitoneal injection of calcein on day 7 and alizarin on day 9, and the calvaria were harvested for micro-CT and histology on day 10. Surprisingly, we found that AOX particles induced significantly more bone resorption (1.72-fold) and osteoclast numbers (1.99-fold) vs. AltrX (p < 0.001). However, AOX also significantly induced 1.64-fold more new bone formation vs. AltrX (p < 0.01). Moreover, while the osteolytic:osteogenic ratio of both particles was very close to 1.0, which is indicative of coupled remodeling, AOX was more osteogenic (Slope = 1.13 ± 0.10 vs. 0.97 ± 0.10). Histomorphometry of the metabolically labeled undecalcified calvaria revealed a consistent trend of greater MAR in AOX vs. AltrX. Collectively, these results demonstrate that anti-oxidant impregnated UHMWPE particles have decreased osteolytic potential due to their increased osteogenic properties that support coupled bone remodeling. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:845-851, 2016., (© 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

This n=40 cohort study on superficial and partial thickness burns compares novel keratin-based products with the standard products used at our facility. The keratin products are found to facilitate healing with minimal scarring, be well tolerated with minimal pain and itch, be easy to use for the health professional and be cost effective for the health care provider. For these reasons they are being adopted into use at our facility., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: There is a paucity of research investigating the scar outcome of children with partial thickness burns. The aim of this study was to assess the scar outcome of children with partial thickness burns who received a silver dressing acutely., Method: Children aged 0-15 years with an acute partial thickness burn, ≤10% TBSA were included. Children were originally recruited for an RCT investigating three dressings for partial thickness burns. Children were assessed at 3 and 6 months after re-epithelialization. 3D photographs were taken of the burn site, POSAS was completed and skin thickness was measured using ultrasound imaging., Results: Forty-three children returned for 3 and 6 month follow-ups or returned a photo. Days to re-epithelialization was a significant predictor of skin/scar quality at 3 and 6 months (p<0.01). Patient-rated color and observer-rated vascularity and pigmentation POSAS scores were comparable at 3 months (color vs. vascularity 0.88, p<0.001; color vs. pigmentation 0.64, p<0.001), but patients scored higher than the observer at 6 months (color vs. vascularity 0.57, p<0.05; color vs. pigmentation 0.15, p=0.60). Burn depth was significantly correlated with skin thickness (r=0.51, p<0.01). Hypopigmentation of the burn site was present in 25.8% of children who re-epithelialized in ≤ 2 weeks., Conclusion: This study has provided information on outcomes for children with partial thickness burns and highlighted a need for further education of this population., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Unlabelled: Antimicrobial medicated dressings (AMD) are often used to reduce bacterial infection of burns and other wounds. However, there is limited literature regarding comparative efficacies to inform effective clinical decision making., Objectives: Following on from a previous study where we demonstrated good antibiofilm properties of acetic acid (AA), we assessed and compared the in vitro anti-biofilm activity of a range of AMDs and non-AMDs to AA., Methods: Laboratory experiments determined the ability of a range of eleven commercial AMD, two nAMD, and AA, to prevent the formation of biofilms of a panel of four isolates of Pseudomonas aeruginosa and Acinetobacter baumannii., Results: There is a large variation in ability of different dressings to inhibit biofilm formation, seen between dressings that contain the same, and those that contain other antimicrobial agents. The best performing AMD were Mepilex(®) Ag and Acticoat. AA consistently prevented biofilm formation., Conclusions: Large variation exists in the ability of AMD to prevent biofilm formation and colonisation of wounds. A standardised in vitro methodology should be developed for external parties to examine and compare the efficacies of commercially available AMDs, along with robust clinical randomised controlled trials. This is essential for informed clinical decision-making and optimal patient management., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Study Design: An in vitro biomechanical study in porcine thoracic spine segments comparing range of motion (ROM) in segmental versus multiple nonsegmental ultrahigh molecular weight polyethylene (UHMWPE) sublaminar wire constructs., Objective: To determine the effect of varying instrumentation (wire) density in an UHMWPE sublaminar wire construct for patients with early-onset scoliosis (EOS) to find an optimal wire density, which allows maximum growth whereas still providing adequate correction and fixation., Summary of Background Data: UHMWPE sublaminar wires in a segmental construct did not negatively affect longitudinal spinal growth during a 24-week period in an ovine model; application in growth guidance system for EOS may therefore be feasible. To avoid ectopic bone formation as much as possible, a reduction of instrumented levels, without affecting spinal stabilization, is desirable., Methods: ROM of 9 porcine thoracic spines (T6-T14) was determined in flexion/extension (FE), lateral bending (LB), and axial rotation up to ± 4 Nm. Tests were performed for the uninstrumented spine in a segmental construct with UHMWPE sublaminar wires and dual pedicle screws at the most caudal level, and in four nonsegmental constructs that were attained by stepwise removal of the most caudal wire., Results: Segmental instrumentation led to a decrease in total ROM by approximately 70% for both FE and LB. A stepwise increase in ROM with decreasing number of consecutively instrumented levels was most clearly observed in LB. However, consistent significant but also relevant substantial differences in ROM for both FE and LB were noted only when comparing two and one consecutively instrumented end levels (P < 0.05)., Conclusion: A construct with two consecutive end levels instrumented with UHMWPE sublaminar wires seems to provide the best balance between spinal stabilization and minimizing the number of instrumented levels and thereby surgical exposure, which is crucial for allowing longitudinal growth., Level of Evidence: N/A.

Burn injuries, the most common and destructive forms of wounds, are generally accompanied with life-threatening infections, inflammation, reduced angiogenesis, inadequate extracellular matrix production, and lack of growth factor stimulation. In the current study, a new antimicrobial carbopol-based hydrogel formulated with boron and pluronic block copolymers was evaluated for its healing activity using in vitro cell culture techniques and an experimental burn model. Cell viability, gene expression, and wound healing assays showed that gel formulation increased wound healing potential. In vitro tube-like structure formation and histopathological examinations revealed that gel not only increased wound closure by fibroblastic cell activity, but also induced vascularization process. Moreover, gel formulation exerted remarkable antimicrobial effects against bacteria, yeast, and fungi. Migration, angiogenesis, and contraction-related protein expressions including collagen, α-smooth muscle actin, transforming growth factor-β1, vimentin, and vascular endothelial growth factor were considerably enhanced in gel-treated groups. Macrophage-specific antigen showed an oscillating expression at the burn wounds, indicating the role of initial macrophage migration to the wound site and reduced inflammation phase. This is the first study indicating that boron containing hydrogel is able to heal burn wounds effectively. The formulation promoted burn wound healing via complex mechanisms including stimulation of cell migration, growth factor expression, inflammatory response, and vascularization.

The mucocele on the inferior orbit is infrequent. When there is occurrence on the inferior orbit, the infraorbital approach, such as transantral, subciliary approach is used commonly. But because of some side effects, the authors use transantral approach intraorally. A 26-year-old woman visited our department with complaint of palpable mass. Computed tomography (CT) disclosed cystic lesion on the left inferior orbit. Surgical approach to the lesion was established with bony window opening on the anterior maxillary wall intralorally. Medpor sheet was placed on orbital floor after the removal of the lesion. Histopathologically, the lesion was diagnosed as mucocele. Orbital volume was kept well after the operation and no ocular sequela was observed.

Aims: To report on the use of Biobrane, a synthetic skin substitute, as a temporary wound cover in patients with severe burn. In particular we wished to examine the role of Biobrane in maintaining a healthy wound bed following surgical excision and identify factors associated with regrafting., Methods: A retrospective case series review was performed on patients with severe burns (≥ 20% TBSA), admitted to the Victorian Adult Burns Service, in Melbourne, from January 2009 to June 2012. Logistic regression analysis was performed to identify factors associated with regrafting., Results: Out of 58 patients with median %TBSA burn of 30%, 22 patients (37.9%) required regrafting of at least one area previously treated with Biobrane and split-skin graft. On univariate analysis, need for regrafting was significantly associated with increasing %TBSA (OR 1.04, 95% CI: 1.01-1.08; p=0.02); and after multivariate analysis to adjust for this effect, hospital LOS (OR 1.04, 95% CI: 1.02-1.07; p=0.001); total operative time (OR 1.16, 95% CI; 1.06-1.28; p=0.002) and total number of surgeries (OR 1.69, 95% CI: 1.27-2.26, p<0.001) remained significantly associated with regrafting. Age, gender, time to surgical debridement and Biobrane application, and anatomical region were not found to be associated with regraft., Conclusion: At our institution, Biobrane has emerged as an alternative option to maintain a healthy wound bed after burn excision and prior to grafting. Our small number of extensive graft failures, small areas of regrafting and low infection rate following Biobrane application reflects our current experience with Biobrane. Precise indications and most appropriate methods for Biobrane use are yet to be established., (Copyright © 2014. Published by Elsevier Ltd.)

Background: This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes., Method: Children (0-15 years) with clean, ≤ 10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat™; (2) Acticoat™ with Mepitel™; or (3) Mepilex Ag™ dressings. Measures of burn re-epithelialization, pain, and distress were recorded at dressing changes every 3-5 days until full re-epithelialization occurred., Results: One hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat™ significantly increased the expected days to full re-epithelialization by 40% (IRR = 1.40; 95% CI: 1.14-1.73, p < 0.01) and Acticoat™ with Mepitel™ significantly increased the expected days to full re-epithelialization by 33% (IRR = 1.33; 95% CI: 1.08-1.63, p ≤ 0.01) when compared to Mepilex Ag™. Expected FLACC scores in the Mepilex Ag™ group were 32% lower at dressing removal (p = 0.01) and 37% lower at new dressing application (p = 0.04); and scores in the Acticoat™ with Mepitel™ group were 23% lower at dressing removal (p = 0.04) and 40% lower at new dressing application (p < 0.01), in comparison to the Acticoat™ group. Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag™ group at dressing removal (p = 0.04) and 34% lower in the Acticoat™ with Mepitel™ group (p = 0.02) at new dressing application in comparison to the Acticoat™ group. There was no significant difference between the Mepilex Ag™ and the Acticoat™ with Mepitel™ groups at all timepoints and with any pain measure., Conclusion: Mepilex Ag™ is an effective silver dressing, in terms of accelerated wound re-epithelialization time (compared to Acticoat™ and Acticoat™ with Mepitel™) and decreased pain during dressing changes (compared to Acticoat™), for clean, < 10% TBSA partial thickness burns in children., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Use of larger diameter femoral heads has emerged as a promising strategy to reduce the risk of dislocation after total hip arthroplasty, but thinning the walls of cross-linked ultra-high-molecular-weight polyethylene (UHMWPE) acetabular liners to accommodate these larger heads may compromise the locking mechanism of the liner. The purpose of this study was to test the mechanical integrity of the locking mechanism in cross-linked and re-melted UHMWPE acetabular components with reduced wall thickness. The locking mechanism of cross-linked (100 kGy/re-melted) acetabular liners in sizes 50/28, 50/36, and 52/36 mm of 1 design was evaluated by lever-out tests and torsion tests. Torsion tests were performed at 2 angles to isolate the liner's locking tabs independent of the contribution of its central post. Lever-out testing demonstrated nominally reduced failure strength in 50/36-mm liners (13.3 N · m) compared with 50/28-mm liners (12.3 N · m; P=.0502), whereas the lever-out strength of 52/36-mm liners was 12.2±0.94 N · m. Failure torques were similar between 50/28- and 50/36-mm liners at 45° and 90°, but the failure torque of size 52/36-mm liners was significantly higher at each angle. The use of larger diameter femoral heads does not compromise the locking mechanism of thinned MicroSeal (Signal Medical Corp, Marysville, Michigan) acetabular liners. Use of a cross-linked UHMWPE acetabular liner, with a locking mechanism that is not compromised when the liner is thinned to a thickness of at least 2.86 mm, appears to be a biomechanically sound construct when articulated with large diameter femoral heads., (Copyright 2015, SLACK Incorporated.)

Objective: To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice., Methods: An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios., Results: On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care., Conclusions: This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care., (Copyright © 2015. Published by Elsevier Inc.)

Background: Postoperative cerebrospinal fluid (CSF) leaks and headaches remain potential complications after retrosigmoid approaches for lesions in the posterior fossa and cerebellopontine angle. The authors describe a simple repair technique with an autologous fat graft-assisted Medpor Titan cranioplasty and investigate the incidence of postoperative CSF leaks and headaches using this technique., Methods: A retrospective chart review was conducted on all cases (n = 60) of retrosigmoid craniectomy from September 2009 to May 2014 in patients who underwent fat graft-assisted cranioplasty. After obtaining a watertight dural closure and sealing off any visible mastoid air cells with bone wax, an autologous fat graft was placed over the dural suture line and up against the waxed-off air cells. The fat graft filled the retrosigmoid cranial defect and was then bolstered with a Medpor Titan (titanium mesh embedded in porous polyethylene) cranioplasty. A postoperative mastoid pressure dressing was applied for 48 h, and prophylactic lumbar drainage was not used. Factors examined in this study included postoperative CSF leak (incisional, rhinorrhea, otorrhea), pseudomeningocele formation, incidence and severity of postoperative headache, length of hospital stay, and length of follow-up., Results: No patients developed postoperative CSF leaks (0 %), pseudomeningoceles (0 %), or new-onset postoperative headaches (0 %) with the described repair technique. There were no cases of graft site morbidity such as hematoma or wound infection. Mean duration of postoperative hospital stay was 3.8 days (range 2-10 days). Mean postoperative follow-up was 12.4 months (range 2.0-41.1 months)., Conclusions: Our multilayer repair technique with a fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leaks and new-onset postoperative headaches after retrosigmoid approaches. Postoperative lumbar drainage may not be necessary.

Unlabelled: Posterior capsule rupture during cataract extraction requires that the intraocular lens (IOL) implanted on top of the capsular bag was stable and well-centered. The objective of this study was to evaluate the results of Rayner C-flex aspheric and M-flex aspheric (United Kingdom) IOLs implantation on top of the capsular bag and their stability in patients with phaco complications., Material and Methods: A total of 2556 phacoemulsification cases were analyzed. Posterior capsule rupture as a complication occurred in 7 cases, that is 0.27%. In all patients Rayner C-flex (5) and M-flex (6) IOLs were implanted on top of the capsular bag according to the initial calculations and with no modifications in the procedure. The 2nd-year follow-up included measurement of the corneal compensated intraocular pressure (IOP) and B-mode and 3D grey-scale ultrasound in order to assess the structures of the anterior segment and to check the position of the IOL., Results: All surgeries yielded positive clinical results. In 2 years after the intervention uncorrected visual acuity averaged 0.7-0.13, corrected-- 0.91+0.07; clinical refraction: sphera-- +0.46 +/- 0.26 diopters, cylinder-- 0.71 +/- 0.29 diopters. The shape and other parameters of Rayner IOLs contribute to their long-term stability. Postoperative lOP in the treated eye was higher than in the fellow nonoperated eye (13.9 +/- 0.76 and 11.8 +/- 0.59 mmHg correspondingly) but the difference lied within the range of normal asymmetry., Conclusion: The 3D ultrasound technology is an informative mean of monitoring the position of the IOL in case of its extracapsular implantation; a comparatively higher IOP in the operated eye does not exceed the range of normal asymmetry between the two eyes; Rayner C-flex and M-flex IOLs remain stable and well-centered after being implanted on top of the capsular bag.

Meniscal tears are the most common orthopedic injuries to the human body, yet the current treatment of choice is a partial meniscectomy, which is known to lead to joint degeneration and osteoarthritis. As a result, there is a significant clinical need to develop materials capable of restoring function to the meniscus following an injury. Fiber-reinforced hydrogel composites are particularly suited for replicating the mechanical function of native fibrous tissues due to their ability to mimic the native anisotropic property distribution present. A critical issue with these materials, however, is the potential for the fiber-matrix interfacial properties to severely limit composite performance. In this work, the interfacial properties of an ultra-high-molecular-weight polyethylene (UHMWPE) fiber-reinforced poly(vinyl alcohol) (PVA) hydrogel are studied. A novel chemical grafting technique, confirmed using X-ray photoelectron spectroscopy, is used to improve UHMWPE-PVA interfacial adhesion. Interfacial shear strength is quantified using fiber pull-out tests. Results indicate significantly improved fiber-hydrogel interfacial adhesion after chemical grafting, where chemically grafted samples have an interfacial shear strength of 256.4±64.3kPa compared to 11.5±2.9kPa for untreated samples. Additionally, scanning electron microscopy of fiber surfaces after fiber pull-out reveal cohesive failure within the hydrogel matrix for treated fiber samples, indicating that the UHMWPE-PVA interface has been successfully optimized. Lastly, inter-fiber spacing is observed to have a significant effect on interfacial adhesion. Fibers spaced further apart have significantly higher interfacial shear strengths, which is critical to consider when optimizing composite design. The results in this study are applicable in developing similar chemical grafting techniques and optimizing fiber-matrix interfacial properties for other hydrogel-based composite systems., (Copyright © 2014 Acta Materialia Inc. All rights reserved.)

Objective: To study the efficacy of endoscopic transcaruncular approach in the repair of isolated medial orbital fracture., Methods: It was a retrospective case series study.Retrospective chart was reviewed in 21 patients (21 eyes) receiving endoscopic transcaruncular approach to reconstruct isolated medial orbital fracture at Quzhou People's Hospital from May 2011 to May 2012., Results: of visual acuity, diplopia, protrusion degree of both eyes and the movement of eye balls was recorded for analysis., Results: All patients were followed up for 8-20 months. There was no extrusion, rejection, infection or other complications of Medpor surgical implant during follow-up. There was no instance of decreased visual acuity at post-operation. The post-operative protrusion degree of both eyes was almost identical at less than 2 mm. The movement of eye balls was satisfactory in all directions. Diplopia disappeared in 13 cases, 1 case improved., Conclusion: Endoscopic transcaruncular approach is a safe and effective treatment in the repair of isolated medial orbital fracture.

Introduction: Studies comparing contemporary silver dressings in burns are scarce., Methods: In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel(®) Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience., Results: Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel(®) Ag dressing was found for average ease of use (p<0.001), average ease of application (p=0.001), patient pain (p<0.001), patient comfort with the dressing (p=0.017), silver staining (p<0.001), and cost effectiveness (p<0.001)., Conclusion: Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel(®) Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

The literature-reported incidence of ophthalmic injuries occurring with facial fracture ranges widely from 0.8% to 30%. Ocular trauma necessitating enucleation or evisceration is less common, but it is not rare. The trauma and physical disability related to removal of the eye are extreme. Moreover, the loss of an eye causes severe changes to the anatomy and physiology of the orbit, resulting in deformities that affect the relationship between the socket and the prosthesis. Here, the authors present their own experience of 8 consecutive cases of trauma injuries with globe loss and emphasize the importance of accurate, early bone reconstruction involving evisceration and immediate socket restoration.

Objective: To investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method., Methods: The first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus. Split-thickness skin was taken from temporal and accipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface., Results: From July 2010 to August 2012, 20 cases (22 ears) were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average, 13 months)., Conclusions: The application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.

Auricular reconstruction using sculpted autologous costal cartilage is effective, but complex and time consuming and may incur donor site sequelae and morbidity. Conventional synthetic alternatives are associated with infection and extrusion in up to about 15% of cases. We present a novel POSS-PCU nanocomposite auricular scaffold, which aims to reduce extrusion rates by mimicking the elastic modulus of human ears and by encouraging desirable cellular interactions. The fabrication, physicochemical properties (including nanoscale topography) and cellular interactions of these scaffolds were compared to Medpor®, the current synthetic standard. Our scaffold had a more similar elastic modulus (5.73 ± 0.17MPa) to ear cartilage (5.02 ± 0.17MPa) compared with Medpor®, which was much stiffer (140.9 ± 0.04MPa). POSS-PCU supported fibroblast ingrowth and proliferation; significantly higher collagen production was also produced by cells on the POSS-PCU than those on Medpor®. This porous POSS-PCU nanocomposite scaffold is therefore a promising alternative biomaterial for auricular surgical reconstruction., From the Clinical Editor: In this paper, a novel POSS-PCU nanocomposite auricular scaffold is described to reduce extrusion rates by having a much closer elastic modulus of human ears than the currently available synthetic standard. Enabling desirable cellular interactions may lead to the successful clinical application of these novel scaffolds., (© 2013.)

Periprosthetic osteolysis is a serious complication of total hip replacement (THR) in the medium to long term. Although often asymptomatic, osteolysis can lead to prosthesis loosening and periprosthetic fracture. These complications cause significant morbidity and require complex revision surgery. Here, we review advances in our understanding of the cell and tissue response to particles produced by wear of the articular and non-articular surfaces of prostheses. We discuss the molecular and cellular regulators of osteoclast formation and bone resorptive activity, a better understanding of which may lead to pharmacological treatments for periprosthetic osteolysis. We describe the development of imaging techniques for the detection and measurement of osteolysis around THR prostheses, which enable improved clinical management of patients, provide a means of evaluating outcomes of non-surgical treatments for periprosthetic osteolysis, and assist in pre-operative planning for revision surgery. Finally, there have been advances in the materials used for bearing surfaces to minimise wear, and we review the literature regarding the performance of these new materials to date.

Background: Wear, oxidation, and particularly rim impingement damage of ultra-high molecular weight polyethylene total disc replacement components have been observed following surgical revision. However, neither in vitro testing nor retrieval-based evidence has shown the effect(s) of impingement on the characteristics of polyethylene wear debris. Thus, we sought to determine (1) differences in polyethylene particle size, shape, number, or biological activity that correspond to mild or severe rim impingement and (2) in an analysis of all total disc replacements, regardless of impingement classification, whether there are correlations between the extent of regional damage and the characteristics of polyethylene wear debris., Methods: The extent of dome and rim damage was characterized for eleven retrieved polyethylene cores obtained at revision surgery after an average duration of implantation of 9.7 years (range, 4.6 to 16.1 years). Polyethylene wear debris was isolated from periprosthetic tissues with use of nitric acid and was imaged with use of environmental scanning electron microscopy. Subsequently, particle size, shape, number, biological activity, and chronic inflammation scores were determined., Results: Grouping of particles by size ranges that represented high biological relevance (&lt;0.1 to 1-μm particles), intermediate biological relevance (1 to 10-μm particles), and low biological relevance (&gt;10-μm particles) revealed an increased volume fraction of particles in the &lt;0.1 to 1-μm and 1 to 10-μm size ranges in the mild-impingement cohort as compared with the severe-impingement cohort. The increased volume fractions resulted in a higher specific biological activity per unit particle volume in the mild-impingement cohort than in the severe-impingement cohort. However, functional biological activity, which is normalized by particle volume (mm3/g of tissue), was significantly higher in the severe-impingement cohort. This increase was due to a larger volume of particles in all three size ranges. In both cohorts, the functional biological activity correlated with the chronic inflammatory response, and the extent of rim penetration positively correlated with increasing particle size, number, and functional biological activity., Conclusions: The results of this study suggest that severe rim impingement increases the production of biologically relevant particles from motion-preserving lumbar total disc replacement components., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The use of space maintenance in mandibular defects as an interim measure before definitive osseous reconstruction may prevent problems associated with delayed reconstruction including increased technical difficulty, contracture of soft tissues that limits the volume of the final reconstruction, and the potential for iatrogenic injury to adjacent anatomical structures. The use of a condyle/ramus spacer made of medical grade, ultrahigh-molecular-weight polyethylene, and a flexible body spacer made of high quality, inert, non-toxic medical and food grade silicone rubber, was tested in 38 patients with mandibular defects after the resection of benign but locally aggressive disease, advanced osteomyelitis, and injuries. The spacer was retained for a maximum of 8 weeks, and was then removed through an extraoral approach before definitive reconstruction with a particulate corticocancellous bone graft. One of the 38 patients failed to attend for follow up and returned 7 months later with severe, generalised sepsis that required removal of the spacer and exclusion from the study. Of the remaining 37 patients, 32 healed uneventfully, 1 required removal of the spacer 2 weeks after implantation for intraoral wound dehiscence, and 4 had mild to moderate disturbances of wound healing that required either minor revision or local wound care until removal at the time of reconstruction. The use of a spacer promotes wound healing and simplifies and expedites secondary reconstruction of mandibular defects., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The Agility total ankle replacement system was the most commonly performed implant in the United States for more than 20 years and has undergone four generations and seven phases of improvement. Much attention has been placed on intraoperative complications, such as malleolar fracture; nerve or tendon injury; and incision healing-related problems, such as wound coverage and infection. However, it is the intermediate- and long-term complications (ie, aseptic osteolysis, subsidence, component loosening, and progressive malalignment) that require careful consideration, because the revision options remain limited. This article reviews the history of the Agility total ankle replacement system in detail, to understand the revision possibilities available., (Copyright © 2013. Published by Elsevier Inc.)

Objectives: To study the effectiveness of a dentifrice containing polyvinylmethyl ether-maleic acid (PVM/MA) copolymer in occluding dentin tubules and investigate the interaction between PVM/MA and type I collagen using surface plasmon resonance (SPR)., Materials and Methods: Fifteen volunteers brushed dentin discs in situ using dentifrices with and without PVM/MA copolymer in a cross-over design. Dentin tubule occlusion was evaluated after brushing, after overnight saliva challenge in vivo for 12 h and after drinking 250 ml of orange juice. Dentin tubule occlusion and tubule size were compared between the two groups using repeated ANOVA and before and after erosive challenges using paired t tests. SPR using type I collagen as ligand and PVM/MA as analyte was performed to evaluate the binding of the two macromolecules., Results: A median of 91% of dentin tubules were occluded after a single brushing in the PVM/MA group, as compared to 9% in the controls. After overnight saliva challenge and 10 min of erosion by orange juice, a median of 73% of the dentin tubules remained fully occluded in the PVM/MA group as compared to zero in the controls. Dentin tubule size increased after orange juice erosion in the controls but not in the PVM/MA group. SPR study showed that PVM/MA bound readily to collagen molecules in a 4 to 1 ratio., Conclusions: Dentifrice containing PVM/MA could effectively occlude dentin tubules and prevent dentin erosion. PVM/MA may improve adhesive retention of intra-tubular dentifrice plugs through binding to dentin surface collagen., Clinical Relevance: Brushing with dentifrice containing adhesive polymers has preventive effect against dentin erosion and dentin sensitivity.

Total ankle replacement has become a popular treatment of symptomatic end-stage ankle osteoarthritis. Contemporary total ankle replacement systems provide more anatomic and biomechanically sound function. However, longevity is still limited and long-term results of modern total ankle replacement designs are not available. In the case of failure, conversion into arthrodesis has remained the treatment of choice but at the cost of hindfoot function and potential degeneration of the adjacent joints. Thus, revision total ankle replacement by exchange of the prosthetic components represents an attractive solution. This article focuses on revision total ankle replacement and conversion to ankle arthrodesis., (Copyright © 2013 Elsevier Inc. All rights reserved.)