Influencia de la atmósfera de sinterización en la estabilidad térmica de cerámicas de hidroxiapatita reforzadas con zircona

En este trabajo se estudia la influencia de la atmósfera de sinterización sobre la estabilidad térmica de cerámicas de hidroxiapatita (HA) reforzadas con partículas de circona parcialmente estabilizada con magnesia (Mg-PSZ). Los cuerpos verdes fueron obtenidos por prensado uniaxial y las sinterizaciones se realizaron en aire y en oxígeno húmedo. El estudio por difracción de rayos-X y espectroscopía infrarroja permitió comprobar que la atmósfera húmeda evita la descomposición de la hidroxiapatita, todo lo contrario a lo que sucede en aire donde es evidente la presencia del zirconato cálcico (CZ) en la interfaz entre la partícula de circona y la matriz de HA. La caracterización microestructural de los materiales por Microscopía Electrónica de Barrido permitió apreciar el desarrollo de tamaño de grano de los materiales sinterizados. El estudio del comportamiento mecánico mediante ensayos de indentación reveló un aumento de la tenacidad a la fractura en el caso de los materiales que presentaban Mg-PSZ con respecto a la HA pura

Effects of silica addition on the chemical, mechanical and biological properties of a new α-Tricalcium Phosphate/Tricalcium Silicate Cement

The addition of tricalcium silicate (C3S) to apatite cements results in an increase of bioactivity and improvement in the mechanical properties. However, adding large amounts raises the local pH at early stages, which retards the precipitation of hydroxyapatite and produces a loss of mechanical strength. The introduction of Pozzolanic materials in cement pastes could be an effective way to reduces basicity and enhance their mechanical resistance; thus, the effect of adding silica on the chemical, mechanical and biological properties of α-tricalcium phosphate/C3S cement was studied. Adding silica produces a reduction in the early pH and a decrease in setting times; nevertheless, the presence of more calcium silicate hydrate (C-S-H) delays the growth of hydroxyapatite crystals and consequently, reduces early compressive strength. The new formulations show a good bioactivity, but higher cytotoxicity than traditional cements and additions higher than 2.5% of SiO2 cause a lack of mechanical strength and an elevated degradability

Preventing the onset of major depression based on the level and profile of risk of primary care attendees: protocol of a cluster randomised trial (the predictD-CCRT study)

BACKGROUND: The 'predictD algorithm' provides an estimate of the level and profile of risk of the onset of major depression in primary care attendees. This gives us the opportunity to develop interventions to prevent depression in a personalized way. We aim to evaluate the effectiveness, cost-effectiveness and cost-utility of a new intervention, personalized and implemented by family physicians (FPs), to prevent the onset of episodes of major depression. METHODS: This is a multicenter randomized controlled trial (RCT), with cluster assignment by health center and two parallel arms. Two interventions will be applied by FPs, usual care versus the new intervention predictD-CCRT. The latter has four components: a training workshop for FPs; communicating the level and profile of risk of depression; building up a tailored bio-psycho-family-social intervention by FPs to prevent depression; offering a booklet to prevent depression; and activating and empowering patients. We will recruit a systematic random sample of 3286 non-depressed adult patients (1643 in each trial arm), nested in 140 FPs and 70 health centers from 7 Spanish cities. All patients will be evaluated at baseline, 6, 12 and 18 months. The level and profile of risk of depression will be communicated to patients by the FPs in the intervention practices at baseline, 6 and 12 months. Our primary outcome will be the cumulative incidence of major depression (measured by CIDI each 6 months) over 18 months of follow-up. Secondary outcomes will be health-related quality of life (SF-12 and EuroQol), and measurements of cost-effectiveness and cost-utility. The inferences will be made at patient level. We shall undertake an intention-to-treat effectiveness analysis and will handle missing data using multiple imputations. We will perform multi-level logistic regressions and will adjust for the probability of the onset of major depression at 12 months measured at baseline as well as for unbalanced variables if appropriate. The economic evaluation will be approached from two perspectives, societal and health system. DISCUSSION: To our knowledge, this will be the first RCT of universal primary prevention for depression in adults and the first to test a personalized intervention implemented by FPs. We discuss possible biases as well as other limitations.Trial registration: ClinicalTrials.gov identifier: NCT01151982

A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial

Abstract Background: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Methods: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months.This work was supported by grants from the Spanish Ministry of Health, the Institute of Health Carlos III (ISCIII) and the European Regional Development Fund (ERDF) ’A way to build Europe’(grant references PS09/02272, PS09/02147, PS09/01095, PS09/00849 and PS09/00461); the Andalusian Council of Health (grant reference PI-0569-2010); the Spanish Network of Primary Care Research ’redIAPP’ (RD06/0018, RD12/0005/0001); the ’Aragón group’ (RD06/0018/0020, RD12/0005/0006); the ’Bizkaya group’ (RD06/0018/0018, RD12/0005/0010); the Castilla-León Group (RD06/0018/0027); the Mental Health (SJD) Barcelona Group (RD06/0018/0017, RD12/0005/0008); and the Mental-Health, Services and Primary Care (SAMSERAP) MálagaGroup (RD06/0018/0039, RD12/0005/0005)

Influencia de la atmósfera de sinterización en la estabilidad térmica de cerámicas de hidroxiapatita reforzadas con circona

En este trabajo se estudia la influencia de la atm sfera de sinterizaci n sobre la estabilidad t rmica de cer micas de hidroxiapatita (HA) reforzadas con part culas de circona parcialmente estabilizada con magnesia (Mg-PSZ). Los cuerpos verdes fueron obtenidos por prensado uniaxial y las sinterizaciones se realizaron en aire y en ox geno h medo. El estudio por difracci n de rayos-X y espectroscop a infrarroja permiti comprobar que la atm sfera h meda evita la descomposici n de la hidroxiapatita, todo lo contrario a lo que sucede en aire donde es evidente la presencia del zirconato c lcico (CZ) en la interfaz entre la part cula de circona y la matriz de HA. La caracterizaci n microestructural de los materiales por Microscop a Electr nica de Barrido permiti apreciar el desarrollo de tama o de grano de los materiales sinterizados. El estudio del comportamiento mec nico mediante ensayos de indentaci n revel un aumento de la tenacidad a la fractura en el caso de los materiales que presentaban Mg-PSZ con respecto a la HA puraPeer reviewe

Influencia de la atmósfera de sinterización en la estabilidad térmica de cerámicas de hidroxiapatita reforzadas con zircona

En este trabajo se estudia la influencia de la atmósfera de sinterización sobre la estabilidad térmica de cerámicas de hidroxiapatita (HA) reforzadas con partículas de circona parcialmente estabilizada con magnesia (Mg-PSZ). Los cuerpos verdes fueron obtenidos por prensado uniaxial y las sinterizaciones se realizaron en aire y en oxígeno húmedo. El estudio por difracción de rayos-X y espectroscopía infrarroja permitió comprobar que la atmósfera húmeda evita la descomposición de la hidroxiapatita, todo lo contrario a lo que sucede en aire donde es evidente la presencia del zirconato cálcico (CZ) en la interfaz entre la partícula de circona y la matriz de HA. La caracterización microestructural de los materiales por Microscopía Electrónica de Barrido permitió apreciar el desarrollo de tamaño de grano de los materiales sinterizados. El estudio del comportamiento mecánico mediante ensayos de indentación reveló un aumento de la tenacidad a la fractura en el caso de los materiales que presentaban Mg-PSZ con respecto a la HA pura

Influencia de la atmosfera de sinterizacion en la estabilidad termica de ceramicas de hidroxiapatita reforzadas con circona

En este trabajo se estudia la influencia de la atmósfera de sinterización sobre la estabilidad térmica de cerámicas de hidroxiapatita (HA) reforzadas con partículas de circona parcialmente estabilizada con magnesia (Mg-PSZ). Los cuerpos verdes fueron obtenidos por prensado uniaxial y las sinterizaciones se realizaron en aire y en oxígeno húmedo. El estudio por difracción de rayos-X y espectroscopía infrarroja permitió comprobar que la atmósfera húmeda evita la descomposición de la hidroxiapatita, todo lo contrario a lo que sucede en aire donde es evidente la presencia del zirconato cálcico (CZ) en la interfaz entre la partícula de circona y la matriz de HA. La caracterización microestructural de los materiales por Microscopía Electrónica de Barrido permitió apreciar el desarrollo de tamaño de grano de los materiales sinterizados. El estudio del comportamiento mecánico mediante ensayos de indentación reveló un aumento de la tenacidad a la fractura en el caso de los materiales que presentaban Mg-PSZ con respecto a la HA pura

Exploring the use of silica sands and calcite from natural deposits to prepare bioactive glasses.

Nowadays bioactive glasses represent one of the most successful bioceramics used for bone tissue restorations. In this work, three types of silica sands (White, Yellow and Gray Sands) and calcite from Cuban natural deposits were employed to synthesize glasses from the system SiO2-CaO-Na2O. The ions released from glasses were evaluated through in vitro tests in Tris-HCl and in simulated body fluids. All sands had purity around 99.2 % of SiO2 and contained traces (ppm) of Zr, Cr, Ba, Ce and Sr ions, while calcite raw material had traces of Sr, Cr, Zr, Ce and Zn. All glasses induced a pH change in Tris-HCl from 7.4 to 9 after 24 h; they had similar ion-release behavior in the in vitro solutions tested and showed a significant bioactive performance after 5 h. This work illustrates the potentialities of the use of natural resources to develop medical products when recognized trademark materials are not available