The Treatment of Very Large Traumatic Bone Defects of the Tibia With a Polycaprolactone-Tricalcium Phosphate 3D-Printed Cage:A Review of Three Cases

The need for an artificial scaffold in very large bone defects is clear, not only to limit the risk of graft harvesting but also to improve clinical success. The use of custom osteoconductive scaffolds made from biodegradable polyester and ceramics can be a valuable patient-friendly option, especially in case of a concomitant infection. Multiple types of scaffolds for the Masquelet procedure (MP) are available. However, these frequently demonstrate central graft involution when defects exceed a certain size and the complication rates remain high. This paper describes three infected tibial defect nonunions with a segmental defect over 10 centimeters long treated with a three-dimensional (3D)-printed polycaprolactonetricalcium phosphate (PCL-TCP) cage in combination with biological adjuncts. Three male patients, between the ages of 37 and 47, were treated for an infected tibial defect nonunion after sustaining Gustilo grade 3 open fractures. All had a segmental midshaft bone defect of more than 10 centimeters (range 11-15cm). First-stage MPs consisted of extensive debridement, external fixation, and placement of anterior lateral thigh flaps. Positive cultures were obtained from all patients during this first stage, which were treated with specific systemic antibiotics for 12 weeks. The second-stage MP was carried out at least two months after the first stage. CT scans were obtained after the first stage to manufacture defect-specific cages. In the final procedure, a custom 3D-printed PCL-TCP cage (Osteopore, Singapore) was placed in the defect in combination with biological adjuncts (BMAC, RIA-derived autograft, iFactor, and BioActive Glass). Bridging of the defect, assessed at six months by CT, was achieved in all cases. SPECT scans six months post-operatively demonstrated active bone regeneration, also involving the central part of the scaffold. All three patients regained function and reported less pain with full weight bearing. This case report shows that 3D-printed PCL-TCP cages in combination with biological adjuncts are a novel addition to the surgical treatment of very large bone defects in (infected) post-traumatic nonunion of the tibia. This combination could overcome some of the current drawbacks in this challenging indication

The Maastrichtian type area (Netherlands–Belgium):a synthesis of 250+ years of collecting and ongoing progress in Upper Cretaceous stratigraphy and palaeontology

Cretaceous limestones near Maastricht (SE Netherlands) have been quarried at least since Roman times. In the late eighteenth century, scientific interest developed in their macrofossil content and specimens were illustrated for the first time. Amongst the early discoveries was a partial skull of a large predatory vertebrate that would play an important role in the emergence of modern palaeontology and our understanding of the con-cept of extinction. After decades of scientific debate, this animal was recognized as a large extinct marine relative of monitor lizards (varanoids) and named Mosasaurus. A detailed lithostratigraphy of Upper Cretaceous (Santonian–Maastrichtian) rocks was established in the Maastrichtian type area during the mid-1970s, which resulted in a renewed interest in fossil hunting by professional and amateur palaeontologists alike. During recent decades, both micro-and macrofossils have enabled a refinement of biozonations, correlations within the basin and with sections elsewhere, a greater insight into taphonomic processes and updated taxonomic interpretations. A new age model and chemostratigraphical framework is the most recent addition, permitting the placement of geoheritage in a larger frame and intensifying outreach to the public, including also virtual and augmented reality and hands-on experience to visitors of museum and (disused) quarries alike

Text - and Datamining beyond borders

Kunstmatige intelligentie (AI) moet toegang hebben tot enormehoeveelheden gegevens om getraind te kunnen worden. Dit artikelbespreekt de behoefte aan passende uitzonderingen voor tekst- endatamining in het auteursrecht, die aan de ene kant de ontwikkelingvan AI stimuleren en tegelijkertijd menselijke auteurs in staatstellen om inkomsten te genereren. De EU, de VS en Japan hebbenverschillende oplossingen gekozen

Analyzing the gut microbiota and microbial-associated metabolites of tomato-based sauces

Red Cooked Sauce (RCS) and Red Raw Sauce (RRS) are a mixture of natural crops that have a promising content of bioactive compounds (BC). The aim was to determine the effect of the indigestible fraction (IF) during the colonic fermentation in RCS and RRS by studying the two-way relationship between gut microbiota composition and microbial metabolites produced from BC fermented in the TNO in vitro dynamic model of the human colon (TIM-2). Total BC in undigested and predigested RRS, 957 and 715 mg/100 g DW, respectively, was significantly higher (p < 0.05) than in the RCS, 571 and 406 mg/100 g DW, respectively. Catenibacterium and Holdemanella increased during RCS fermentation, while 13 genera showed a clear positive correlation with most microbial phenolic metabolites. Our findings suggest that the mechanisms, pathways, and enzymes involved in producing microbial metabolites exhibited uniqueness among bacterial taxa, even within shared genus/family classifications

Germany's positioning in the triangular relations with Russia and the US:towards a (new) European security order?

Growing great power competition, a changing security environment and the acclaimed de-institutionalisation of security policy in the twenty-first century demand adaptations in national security approaches and institutional settings. States have benefitted differently from the post-Cold War European security order. While Germany presents itself as a prime beneficiary from Europe's multilateral structures, the US has sought to shift its focus away from Europe, and Russia's foreign policy has become increasingly aggressive, eventually culminating in the return of war to Europe. Such developments lead to new transformations and fundamental re-arrangements of the present security order that require states to rethink their national foreign and security policies and relationships. This article examines the relations between Germany, Russia and the US using the analytical concept of triangular relations. Used as an analytical tool, the examination of the Germany-Russia-US triangular relationship helps to investigate and trace how we got to the contemporary European security order

Understanding Political Economy:Capitalism, Democracy and Inequality

This timely book provides a critical discussion of the leading concepts and theories in political economy. Bob Hancké, Toon Van Overbeke and Dustin Voss conduct a historical and thematic review of the evolution of political-economic thought, revolving around the relation between capitalism and democracy

Germany's positioning in the triangular relations with Russia and the US:towards a (new) European security order?

Growing great power competition, a changing security environment and the acclaimed de-institutionalisation of security policy in the twenty-first century demand adaptations in national security approaches and institutional settings. States have benefitted differently from the post-Cold War European security order. While Germany presents itself as a prime beneficiary from Europe's multilateral structures, the US has sought to shift its focus away from Europe, and Russia's foreign policy has become increasingly aggressive, eventually culminating in the return of war to Europe. Such developments lead to new transformations and fundamental re-arrangements of the present security order that require states to rethink their national foreign and security policies and relationships. This article examines the relations between Germany, Russia and the US using the analytical concept of triangular relations. Used as an analytical tool, the examination of the Germany-Russia-US triangular relationship helps to investigate and trace how we got to the contemporary European security order

Long term functioning with poor neurologic outcome after cardiac arrest

AIM: Around six percent of comatose patients after cardiac arrest have a Cerebral Performance Categories score of three (CPC3) at six months after the arrest, classified as severe neurological disability. There is limited knowledge regarding the likelihood of further recovery in the cognitive, emotional, and quality of life domains. We aimed to estimate the probability of recovery towards independency. METHODS: From a prospective Registry on comatose cardiac arrest patients admitted between 2013 and 2017 in two Dutch hospitals, we included patients with a CPC3 at six months after cardiac arrest. We followed patients up to November 2023. The primary outcome measure was the CPC score at time of follow up. Secondary outcomes were scores on questionnaires on cognition, mood, and quality of life according to the minimal dataset of acquired brain injury. RESULTS: In our cohort of 667 patients, 29 (4.3%) had a CPC3 score at six months (median age 68 years, 83% male). At a median time of eight years after cardiac arrest, sixteen patients had died. Twelve of thirteen alive patients still had a CPC3 score (92%) and one a CPC2 (8%). Seven patients agreed with further interviewing, one showed independency in activities of daily living (14%). Six patients (86%) reported limitations due to physical and one (14%) due to emotional problems. All had severe cognitive impairment. Six (86%) missed cognitive rehabilitation. CONCLUSION: Our study shows that while the probability of recovery towards independence for patients with severe neurological disability at six months after cardiac arrest is limited, most long-term survivors are satisfied with their quality of life