3-D Printed Protective Equipment during COVID-19 Pandemic

While the number of coronavirus cases from 2019 continues to grow, hospitals are reporting shortages of personal protective equipment (PPE) for frontline healthcare workers. Furthermore, PPE for the eyes and mouth, such as face shields, allow for additional protection when working with aerosols. 3-D printing enables the easy and rapid production of lightweight plastic frameworks based on open-source data. The practicality and clinical suitability of four face shields printed using a fused deposition modeling printer were examined. The weight, printing time, and required tools for assembly were evaluated. To assess the clinical suitability, each face shield was worn for one hour by 10 clinicians and rated using a visual analogue scale. The filament weight (21-42 g) and printing time (1:40-3:17 h) differed significantly between the four frames. Likewise, the fit, wearing comfort, space for additional PPE, and protection varied between the designs. For clinical suitability, a chosen design should allow sufficient space for goggles and N95 respirators as well as maximum coverage of the facial area. Consequently, two datasets are recommended. For the final selection of the ideal dataset to be used for printing, scalability and economic efficiency need to be carefully balanced with an acceptable degree of protection

Impurities in commercial titanium dental implants – A mass and optical emission spectrometry elemental analysis

Objective: Titanium (Ti) is considered bioinert and is still regarded as the “gold standard” material for dental implants. However, even ‘commercial pure’ Ti will contain minor fractions of elemental impurities. Evidence demonstrating the release of Ti ions and particles from ‘passive’ implant surfaces is increasing and has been attributed to biocorrosion processes which may provoke immunological reactions. However, Ti observed in peri-implant tissues has been shown to be co-located with elements considered impurities in biomedical alloys. Accordingly, this study aimed to quantify the composition of impurities in commercial Ti dental implants. Methods: Fifteen commercial titanium dental implant systems were analyzed using inductively coupled plasma-mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES). Results: The elemental composition of implants manufactured from commercially pure grades of Ti, Ti-6Al-4V, and the TiZr alloy (Roxolid) conformed to the respective ISO/ASTM standards or manufacturers´ data (TiZr/Roxolid). However, all implants investigated included exogenous metal contaminants including Ni, Cr, Sb, and Nb to a variable extent. Other contaminants detected in a fraction of implants included As and the radionuclides U-238 and Th-232. Significance: Although all Ti implant studies conformed with their standard compositions, potentially allergenic, noxious metals and even radionuclides were detected. Since there are differences in the degree of contamination between the implant systems, a certain impurity fraction seems technically avoidable. The clinical relevance of these findings must be further investigated, and an adaptation of industry standards should be discussed

Characterization of macrophages infiltrating periâ implantitis lesions

ObjectivesThe mechanisms involved in the initiation and progression of periâ implantitis lesions are poorly understood. It was the aim to determine the content and activation status of macrophages present in human periâ implantitis lesions and compare the current findings with the macrophage polarization associated with periodontitis lesions.Material and MethodsA total of 14 patients were studied in this investigation. Seven were soft tissue biopsies from dental implants affected by periâ implantitis that required explantation. Seven biopsies were from chronic periodontal disease. Immunofluorescence stains were performed using biomarkers to identify macrophages (CD68+) undergoing M1 polarization (iNOS+) and M2 polarization (CD206+), along with Hoechst 33,342 to identify DNA content. All samples were stained and photographed, and doubleâ positive cells for CD68 and iNOS or CD68 and CD206 were quantified.ResultsAll periâ implantitis biopsies examined revealed a mixed population of macrophages undergoing M1 polarization and M2 polarization. Further analysis demonstrated the coâ expression of iNOS and CD206, which indicates the presence of a heterogenic immune response on periâ implantitis lesions. Macrophage polarization in periâ implantitis lesions presents a distinct pattern than in periodontitis. We observed a significant increase in the population of M1 macrophages on periâ implantitis samples compared to periodontal disease samples.ConclusionOur results demonstrate that periâ implantitis has higher numbers of macrophages displaying a distinct macrophage M1 polarization signature compared to periodontitis lesions. This pattern may explain, in part, the distinct nature of periâ implantitis progression vs. periodontitis in humans.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154542/1/clr13568_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154542/2/clr13568.pd

Characterization of macrophage polarization in periodontal disease

AimTo explore the M1/M2 status of macrophage polarization from healthy, gingivitis, and periodontitis patient samples.Materials and methodsGingival biopsies were collected from 42 individuals (14 gingivitis, 18 periodontitis, and 10 healthy samples) receiving periodontal therapy. Histomorphology analysis was performed with haematoxylin and eosin staining. Immunofluorescence was performed using a combination of CD68 (macrophages), iNOS (M1), and CD206 (M2) in order to acquire changes in macrophage polarization at a singleâ cell resolution. Macrophages were quantified under microscopy using narrow wavelength filters to detect Alexa 488, Alexa 568, Alexa 633 fluorophores, and Hoechst 33342 to identify cellular DNA content.ResultsGingivitis and periodontitis samples showed higher levels of macrophages compared with healthy samples. Unexpectedly, periodontitis samples displayed lower levels of macrophages dispersed in the stromal tissues compared with gingivitis samples; however, it remained higher than healthy tissues. The polarization of macrophages appears to be reduced in periodontitis and showed similar levels to those observed in healthy tissues.ConclusionsOur study found that gingivitis and periodontitis differ from each other by the levels of macrophage infiltrate, but not by changes in macrophage polarization.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150506/1/jcpe13156_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150506/2/jcpe13156.pd

Micropatterned Scaffolds with Immobilized Growth Factor Genes Regenerate Bone and Periodontal Ligament‐Like Tissues

Periodontal disease destroys supporting structures of teeth. However, tissue engineering strategies offer potential to enhance regeneration. Here, the strategies of patterned topography, spatiotemporally controlled growth factor gene delivery, and cell‐based therapy to repair bone–periodontal ligament (PDL) interfaces are combined. Micropatterned scaffolds are fabricated for the ligament regions using polycaprolactone (PCL)/polylactic‐co‐glycolic acid and combined with amorphous PCL scaffolds for the bone region. Scaffolds are modified using chemical vapor deposition, followed by spatially controlled immobilization of vectors encoding either platelet‐derived growth factor‐BB or bone morphogenetic protein‐7, respectively. The scaffolds are seeded with human cells and delivered to large alveolar bone defects in athymic rats. The effects of dual and single gene delivery with and without micropatterning are assessed after 3, 6, and 9 weeks. Gene delivery results in greater bone formation at three weeks. Micropatterning results in regenerated ligamentous tissues similar to native PDL. The combination results in more mature expression of collagen III and periostin, and with elastic moduli of regenerated tissues that are statistically indistinguishable from those of native tissue, while controls are less stiff than native tissues. Thus, controlled scaffold microtopography combined with localized growth factor gene delivery improves the regeneration of periodontal bone–PDL interfaces.For bone–ligament tissue regeneration, a combined strategy of patterned polymeric scaffolds, spatiotemporally controlled growth factor gene delivery, and cell‐based therapy is used. Polycaprolactone (PCL)/polylactic‐co‐glycolic acid scaffolds with microtopography and amorphous PCL scaffolds, combined with chemical vapor deposition for immobilization of gene therapy vectors, improve the regeneration of periodontal bone–periodontal ligament interfaces.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146594/1/adhm201800750-sup-0001-S1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146594/2/adhm201800750_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146594/3/adhm201800750.pd

Analgosedierung oder Intubationsnarkose zur endovaskulären Therapie des akuten ischämischen Schlaganfalls – Vergleich von Durchführbarkeit, periprozeduraler Sicherheit sowie klinischem und radiologischem Outcome

Der Schlaganfall ist nach Herz- und Krebsleiden die dritthäufigste Todesursache in den westlichen Industrieländern und einer der Hauptgründe für eine permanente Behinderung. Ein entscheidender Faktor in der Therapie des akuten ischämischen Schlaganfalls ist die Rekanalisation des Gefäßverschlusses. Endovaskuläre Therapieverfahren, sowohl medikamentöse als auch mechanische, spielen eine immer bedeutendere Rolle. Es gibt keinen Konsens darüber, ob für solche Intervention eine Intubationsnarkose (ITN) notwendig ist oder eine lokale Anästhesie (LA) im Zugangsbereich erfolgen sollte. Ziel der Studie war es, die Durchführbarkeit der lokalen Schlaganfalltherapie unter lokaler Anästhesie zu evaluieren. Über einen Zeitraum von fünf Jahren wurden 131 Patienten mit einem akut ischämischen Schlaganfall eingeschlossen. Die endovaskuläre Therapie erfolgte als lokale intraarterielle Thrombolyse, als primäre mechanische Rekanalisation oder als Kombinationstherapie. Die systematische Auswertung erfolgte retrospektiv hinsichtlich Rekanalisationsrate, primärem anästhesiologischem Vorgehen, Konversion von lokaler Anästhesie zu Intubationsnarkose, neurologischem Outcome sowie postinterventionellen Komplikationen. Von den 124 Patienten (mittleres Alter 68,8 ± 14,6) waren 65 weiblich (52,4 %) und 59 (47,6 %) männlich. Der Verschluss lag bei 94 Patienten (75,8 %) im vorderen, bei 30 Patienten (24,4 %) im hinteren Stromgebiet. 105 Patienten (84,7 %) wurden in lokaler Anästhesie, 16 Patienten (12,9 %) primär in ITN behandelt. In 3 Fällen (2,4 %) erfolgte eine Konversion von LA in ITN. Eine primäre Lyse bzw. mechanische Rekanalisation erfolgte bei 60 (48,4 %) bzw. 27 (21,8 %) Patienten, in 37 Fällen (29,8 %) erfolgte eine Kombination beider Verfahren. Zwischen der LA- und ITN-Gruppe bestand weder hinsichtlich Rekanalisationsrate noch peri- oder postinterventionellen Komplikationen ein statistisch signifikanter Unterschied. Das finale Infarktvolumen war bei Behandlung in Lokalanästhesie signifikant kleiner (p = 0.024). Lokal rekanalisierende Verfahren in der Therapie des akut ischämischen Schlaganfalls sind unter lokaler Anästhesie und bedarfsweiser Analgosedierung mit niedrigem Risikoprofil möglich und scheinen zu einem geringeren Infarktvolumen und besserem klinischen und radiologischem Outcome zu führen.Vessel recanalization is an important predictor of clinical outcome in the treatment of acute ischemic stroke. Endovascular therapies are used with increasing frequency. There is no general agreement on the policy of anesthesia during endovascular therapy, ranging from general anesthesia (GA) to local anesthesia at the puncture site with conscious sedation (CS) as needed. The aim of the study was to evaluate the safety and feasibility and radiological and clinical outcome of endovascular stroke therapy under CS. We retrospectively included all patients with acute ischemic stroke who were treated with endovascular therapy over a five-year period. Data was evaluated with respect to type of sedation, conversion from CS to GA, recanalization rate, infarct volume and peri- and postprocedural complications. There was a technical failure in 7 patients. Of the remaining 124 patients (mean age 68.8 ± 14.6 years), 65 were female (52 %). The site of occlusion was located in the anterior circulation in 94 patients (76 %) and in the posterior circulation in 30 cases (24 %). 105 patients (85 %) were treated under CS and 16 cases (13 %) primarily under GA. In 3 cases (2 %) periprocedural conversion to GA was necessary. Primary intraarterial thrombolysis, mechanical recanalization only, and combination therapy were performed in 60 (48 %), 27 (22 %) and 37 (30 %) patients, respectively. There were no significant differences for recanalization rate and complications between GA and CS. The mean procedure time was significantly shorter in patients treated under CS (p < 0.01). Endovascular stroke therapy with CS is feasible, can be performed safely and is faster than with GA

Situationsanalyse als Grundlage für eine Kampagne zum Thema Organspende

Eine evidenzbasierte Konzeption von Kommunikationskampagnen im Gesundheitsbereich ist unerlässlich, um Effektivität und Wirksamkeit zu erhöhen (Bonfadelli & Friemel, 2010; Rossmann, 2015). Entsprechend der aus der Medizin stammenden Forderung nach evidenzbasiertem Vorgehen sollen also wissenschaftliche Befunde und die Erfahrung und Expertise aus der Praxis systematisch berücksichtigt werden (Sackett et al., 1996). Dies findet im Rahmen der Planung und Evaluation von Kampagnen zwar teilweise statt (Michie et al., 2014; Noar, 2006), der Transfer aus der Wissenschaft in die Praxis wird aber insgesamt noch immer als unbefriedigend wahrgenommen (Glanz, Rimer, & Viswanath, 2015; Kreps, 2012). Die Prinzipien des evidenzbasierten Vorgehens und die Berücksichtigung wissenschaftlicher Grundlagen sind vor allem zu Beginn der Kampagnenplanung in Form einer fundierten Situationsanalyse nötig (Friemel & Frey, 2017). Eine systematische Situationsanalyse untersucht das anzugehende Problem, eruiert relevante Einflussfaktoren auf zu verändernde Verhaltensweisen sowie Einstellungen und erarbeitet darauf aufbauend die Zielgruppendefinition und Empfehlungen zur Kommunikationsstrategie. Nur so können eine evidenzbasierte Konzeption und letztlich auch die evidenzbasierte Durchführung einer Kampagne garantiert werden. Im Rahmen dieses Beitrags werden zunächst anhand von theoretischen Überlegungen die zentralen Elemente einer Situationsanalyse erläutert. Im Anschluss wird am Beispiel einer durchgeführten Situationsanalyse im Rahmen der Kampagnenplanung zum Thema Organspende aufgezeigt, wie eine Umsetzung in der Praxis geschehen kann. Dabei wird auf die methodische Herangehensweise, die Ergebnisse der Situationsanalyse und die Ableitung von Empfehlungen für die darauf basierende Kommunikationskampagne eingegangen