Wear and corrosion interactions on titanium in oral environment : literature review

The oral cavity is a complex environment where corrosive substances from dietary, human saliva, and oral biofilms may accumulate in retentive areas of dental implant systems and prostheses promoting corrosion at their surfaces. Additionally, during mastication, micromovements may occur between prosthetic joints causing a relative motion between contacting surfaces, leading to wear. Both processes (wear and corrosion) result in a bio-tribocorrosion system once that occurs in contact with biological tissues and fluids. This review paper is focused on the aspects related to the corrosion and wear behavior of titanium-based structures in the oral environment. Furthermore, the clinical relevance of the oral environment is focused on the harmful effect that acidic substances and biofilms, formed in human saliva, may have on titanium surfaces. In fact, a progressive degradation of titanium by wear and corrosion (tribocorrosion) mechanisms can take place affecting the performance of titanium-based implant and prostheses. Also, the formation of wear debris and metallic ions due to the tribocorrosion phenomena can become toxic for human tissues. This review gathers knowledge from areas like materials sciences, microbiology, and dentistry contributing to a better understanding of bio-tribocorrosion processes in the oral environment.(undefined

The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)

Background: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). Methods/Design: In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and powe

Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

Contains fulltext : 69534.pdf (publisher's version ) (Open Access)BACKGROUND: With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction.The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. METHODS/DESIGN: The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. DISCUSSION: The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. TRIAL REGISTRATION: Nederlands Trial Register NTR1150

A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial)

Background. Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy. It is, however, uncertain whether patients with acute diverticulitis indeed benefit from antibiotics. In most guidelines issued by professional organizations antibiotics are considered mandatory in the treatment of mild diverticulitis. This advice lacks evidence and is merely based on experts' opinion. Adverse effects of the use of antibiotics are well known, including allergic reactions, development of bacterial resistance to antibiotics and other side-effects. Methods. A randomized multicenter pragmatic clinical trial comparin

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy.

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques

A spray based method for biofilm removal

Biofilm growth on human teeth is the cause of oral diseases such as caries (tooth decay), gingivitis (inflammation of the gums) and periodontitis (inflammation of the tooth bone). In this thesis, a water based cleaning method is designed for removal of oral biofilms, or dental plaque. The first part of the work was done in the context of a two-year post-graduate study at the Stan Ackermans Institute of the Technische Universiteit Eindhoven. Five water-based cleaning concepts were evaluated on efficacy, safety and ease of use. The efficacy of the concepts was tested on real plaque in the mouth, and on artificial plaque layers. The latter consisted of a mixture of Poly(VinylAlcohol)-SBQ and latex particles in water (PVA), which was gelated by ultraviolet light. If it was technically impossible or if it was not safe to test the concepts in the mouth, the concept was only tested on artificial plaque. Different series of preliminary experiments on the removal of PVA layers were performed with water jets, water jets with air bubbles, spray jets with and without abrasive particles and ultrasound. Spray jets with or without abrasive particles performed better than water jets with and without air bubbles and better than ultrasound. Some further experiments were done to characterize the air assisted water sprays for different air pressures and water flow rates. Droplet diameters between 5 and 200 micrometers and droplet velocities between 10 and 100 meters per second were found for supply pressures in between 1 and 2 bar. The effect of the adjustable parameters of the spray, i.e. the air pressure and the water flow rate, on the cleaning efficacy was determined. Since the concept of a spray jet (without abrasive particles) was proven to be effective for plaque removal on real human teeth, it was decided to investigate the effect of spray parameters on cleaning efficacy in detail. In this way, the exact mechanism of plaque removal could be better understood, which was essential to optimize the system parameters. As a first step, an improved substitute for dental plaque was developed. The model comprised a biofilm build from Streptococcus mutans bacteria, naturally present in human plaque, that was grown on glass plates under favorable conditions. The biofilm was characterized mechanically by a micro-indentation device, in which a small indenter was pressed into the biofilm. The process was visually observed with a confocal microscope. The visual observations and the force-displacement curves of the indenter showed that the biofilm is a porous visco-elastic solid that has a tangential elasticity modulus ranging from 1-15 kPa at a strain of 10%. Second, different sprays with known size-velocity distributions were used to perform laboratory experiments in which a biofilm was exposed for a short time to the spray. Now, the cleaning efficacy of the spray could directly be linked to the parameters of the spray. In order to improve the experimental conditions, experiments were repeated with pencil jets, which have reasonably uniform droplets both in size and in velocity. The relationship between biofilm removal rate and droplet parameters was determined. It was found that two phases can be distinguished in the removal process. In the penetration phase, the droplets gradually remove biofilm until the substrate. In the subsequent growth phase, the existing cleaned area increases in time. It was found that the growth rate scales with the cube of the droplet velocity and with the square of the droplet diameter. It was concluded that biofilm is removed more efficiently during the growth phase than during the penetration phase. For a complete overview, numerical simulations were done of impacting droplets on solid surfaces which were either dry or covered by a thin water film. The temporal behavior of the pressure and the shear stress on the solid surface was determined as a function of the droplet’s initial velocity and diameter. The pressures on the surface scale with the stagnation pressure, while the shear stresses scale with the square root of the velocity and the square root of the diameter. It was established that the presence of a water film on the solid surface strongly decreases the magnitude of the stresses involved and quantitative estimates for these reducing effects of water films were found. For cleaning of a certain area with a given volume of water in a given time, regime diagrams were constructed for the penetration phase and for the growth phase. The efficacy of biofilm removal with monodisperse droplet streams was given as a function of the droplet velocity and the droplet diameter

Cytoskeletal Alteration and Change of Retinal Nerve Fiber Layer Birefringence in Hypertensive Retina

Purpose: Glaucoma damages the retinal nerve fiber layer (RNFL). Both RNFL thickness and retardance can be used to assess the damage, but birefringence, the ratio of retardance to thickness, is a property of the tissue itself. This study investigated the relationship between axonal cytoskeleton and RNFL birefringence in retinas with hypertensive damage. Materials and Methods: High intraocular pressure (IOP) was induced unilaterally in rat eyes. RNFL retardance in isolated retinas was measured. Cytostructural organization and bundle thickness were evaluated by confocal imaging of immunohistochemical staining of the cytoskeletal components: microtubules (MTs), F-actin, and neurofilaments. Bundles with different appearances of MT stain were studied, and their birefringence was calculated at different radii from the optic nerve head (ONH) center. Results: Forty bundles in eight normal retinas and 37 bundles in 10 treated retinas were examined. In normal retinas, the stain of axonal cytoskeleton was approximately uniform within bundles, and RNFL birefringence did not change along bundles. In treated retinas, elevation of IOP caused non-uniform alteration of axonal cytoskeleton across the retina, and distortion of axonal MTs was associated with decreased birefringence. The study further demonstrated that change of RNFL birefringence profiles along bundles can imply altered axonal cytoskeleton, suggesting that ultrastructural change of the RNFL can be inferred from clinical measurements of RNFL birefringence. The study also demonstrated that measuring RNFL birefringence profiles along bundles, instead of at a single location, may provide a more sensitive way to detect axonal ultrastructural change. Conclusions: Measurement of RNFL birefringence along bundles can provide estimation of cytoskeleton alteration and sensitive detection of glaucomatous damage

Adaptive optics and the eye (super resolution OCT)

The combination of adaptive optics (AO) and optical coherence tomography (OCT) was first reported 8 years ago and has undergone tremendous technological advances since then. The technical benefits of adding AO to OCT (increased lateral resolution, smaller speckle, and enhanced sensitivity) increase the imaging capability of OCT in ways that make it well suited for three-dimensional (3D) cellular imaging in the retina. Today, AO–OCT systems provide ultrahigh 3D resolution (3 × 3 × 3 μm3) and ultrahigh speed (up to an order of magnitude faster than commercial OCT). AO–OCT systems have been used to capture volume images of retinal structures, previously only visible with histology, and are being used for studying clinical conditions. Here, we present representative examples of cellular structures that can be visualized with AO–OCT. We overview three studies from our laboratory that used ultrahigh-resolution AO–OCT to measure the cross-sectional profiles of individual bundles in the retinal nerve fiber layer; the diameters of foveal capillaries that define the terminal rim of the foveal avascular zone; and the spacing and length of individual cone photoreceptor outer segments as close as 0.5° from the fovea center