Device to Deliver Endodontic Material for Temporary Dental Fillings

Root canal therapy requires patients be treated over several visits to clean and shape the pulp chamber. In endodontic treatments, cotton wool is placed beneath the temporary filling to preserve the space of the pulp chamber and to prevent any blockage of the root canals with temporary filling between clinic visits. Despite its simple application and affordability, cotton wool can lead to fibrous remnants in the pulp chamber or become incorporated into the temporary filling, which can lead to micro-leakage or bacterial colonization on the cotton fibers and subsequent infection. Gelatin capsules or silica gels are proposed endodontic materials which can replace cotton wool in root canal therapy by creating a barrier for entry into the root canals and conferring mechanical stability to the temporary filling above. An innovative and clinically suitable delivery device is required to catalyze the use of novel endodontic materials in place of cotton wool during root canal therapy. The proposed solution is a device that will deliver a variety of endodontic material into the pulp cavity. The device will be comprised of customizable, disposable attachments that will contain sufficient endodontic material to fill the tooth and a permanent base that will house a mechanically operated delivery system. The design team has created several concept designs for the dental device and narrowed them down as a group using evaluation criteria such as potential clinical feasibility, functionality, and utility. After overcoming initial difficulty with 3D drafting, 3D designs of the selected concept device have been developed and preliminary 3D model has been printed using ABS polymer. These preliminary models allow for analysis of size, weight, and handling and will allow for the further development and refinement of our design. Upon recognizing the need for further exploration of the potential user market, an online survey was created and distributed to better understand the preferences of clinicians with regards to dental devices. Responses from the School of Dentistry faculty are currently being collected and analyzed. In addition, an initial estimation of the project budget, including 3D printing and proposed materials for prototyping, was made. The focus of the team is currently centered on the ideation of the delivery mechanism, creation of customizable accessory attachments, and determination of prototyping strategy.https://scholarscompass.vcu.edu/capstone/1000/thumbnail.jp

Preclinical Testing of a Novel Niclosamide Stearate Prodrug Therapeutic (NSPT) shows efficacy against Osteosarcoma

Therapeutic advances for osteosarcoma (OS) have stagnated over the past several decades, leading to an unmet clinical need for patients. The purpose of this study was to develop a novel therapy for OS by reformulating and validating niclosamide, an established anthelminthic agent, as a Niclosamide Stearate Prodrug Therapeutic (NSPT). We sought to improve the low and inefficient clinical bioavailability of oral dosing, especially for the relatively hydrophobic classes of anti-cancer drugs. Nanoparticles were fabricated by rapid-solvent shifting and verified using dynamic light scattering and UV-vis spectrophotometry. NSPT efficacy was then studied in vitro for cell-viability, cell-proliferation, intracellular-signaling by western blot; ex vivo pulmonary metastatic assay model; and in vivo PK and lung mouse metastatic model of OS. NSPT formulation stabilizes niclosamide stearate against hydrolysis and delays enzymolysis; increases circulation in vivo with t1/2 ~5 h; reduces cell-viability and cell-proliferation in human and canine OS cells in vitro at 0.2 - 2 µM IC50; inhibits recognized growth pathways, and induces apoptosis at 20µM; eliminates metastatic lesions in the ex-vivo lung metastatic model; and, when injected intravenously (i.v.) at 50mg/kg weekly, it prevents metastatic spread in the lungs in a mouse model of OS over 30 days. In conclusion, niclosamide was optimized for preclinical drug delivery as a unique prodrug nanoparticle injected i.v. at 50mg/kg (1.9mM). This increased bioavailability of niclosamide in the blood stream prevented metastatic disease in the mouse. This chemotherapeutic strategy is now ready for canine trials, and if successful, will be targeted for human trials in OS patients

In-Hospital Complications and Costs of Simultaneous Bilateral Total Hip Arthroplasty: The Case for Selection and Potential Cost Savings

Published comparisons between bilateral and unilateral total hip arthroplasty (THA) remain controversial regarding the potential risks and benefits. Our objectives were to compare (1) postoperative complications and (2) resource utilization of patients having simultaneous bilateral THA with patients having unilateral procedures. The Nationwide Inpatient Sample was used to identify patients undergoing primary elective THA from January 2016 to December 2019. Complications and costs were compared between unilateral and simultaneous bilateral patients. Binary logistic regression analysis controlling demographics, comorbidities, and the primary diagnosis was performed to compare the cohorts of unilateral and bilateral patients. Nine thousand nine hundred fifty-five Bilateral procedures and 785,609 unilateral procedures were identified. Patients with bilateral procedures were at increased risk for many medical complications including gastrointestinal complications (OR: 4.1; 95% CI: 2.4-6.9, < .01), postoperative blood transfusions (OR: 3.6; 95% CI: 3.3-3.9, < .01), and pulmonary embolisms (OR: 3.2; 95% CI: 2.0-5.1, < .01). Patients with bilateral procedures were also at increased risk for joint complications, including periprosthetic fractures (OR: 7.4; 95% CI: 5.2-10.5, < .01) and other mechanical complications (OR: 27.0; 95% CI: 23-30, < .01). These patients also incurred higher index hospitalization costs ($25,347 vs$16,757, < .001) and were discharged more commonly to a rehabilitation facility (17.8% vs 13.4%, < .001). Bilateral THA are at increased risk of developing postoperative complications despite being younger and having fewer comorbidities on average when compared with unilateral patients. While bilateral patients had a higher index hospitalization cost, the overall cost of one episode of care is lower than two separate hospitalizations

Virtual Versus In-person Grand Rounds in Orthopaedics: A Framework for Implementation and Participant-reported Outcomes

INTRODUCTIONGrand rounds have been weekly gatherings at academic orthopaedic surgery programs across the country for decades. During the 50th year of grand rounds at our institution, the COVID-19 pandemic prompted the transformation of this in-person forum into a virtual setting. The purpose of this study was to detail this initiative and to report survey data providing participant-reported perceptions and satisfaction of virtual versus in-person grand rounds. MATERIALS AND METHODSOnce in-person meetings were discontinued, virtual grand rounds commenced using the Zoom video application. At the conclusion of the 2020 to 2021 academic year, a 30-item online survey was sent to all residents, faculty, and visiting faculty to assess their perspective and satisfaction. A five-point Likert scale ranging from 1 to 5, with 5 being extremely effective, was used. A 21-item follow-up survey was sent to all speakers as well. RESULTSThirty-six virtual grand rounds were successfully hosted. The response rate for the survey was excellent-80 of 86 (93.0%) surveys returned completed. Respondents found that virtual grand rounds were more convenient to attend, were more convenient to obtain Continuing Medical Education, and were more satisfied with virtual grand rounds. Respondents reported that in-person grand rounds were more effective for stimulating social collegiality and networking. Speakers found that virtual grand rounds were more effective for uploading the presentation and overall convenience, whereas they were less effective at retaining audience attention and receiving audience feedback. Improved faculty attendance after the switch to virtual grand rounds was also noted. CONCLUSIONThis study found that respondents across all groups appreciated the convenience of attending and obtaining Continuing Medical Educations at virtual grand rounds while also noting the merits of in-person grand rounds for promoting peer interaction, camaraderie, and departmental identity. All respondents strongly recommended continuation of this program in a hybrid format. Virtual orthopaedic grand rounds are viable, readily implemented and demonstrate improved participant satisfaction

Chronic Opioid Use Independently Increases Complications and Resource Utilization After Primary Total Joint Arthroplasty

Current literature suggests a link between the chronic use of opioids and musculoskeletal surgical complications. Given the current opioid epidemic, the need to elucidate the effects of chronic opioid use (OD) on patient outcomes and cost has become important. The purpose of this study was to determine if OD is an independent risk factor for inpatient postoperative complications and resource utilization after primary total joint arthroplasty. A total of 3,545,565 patients undergoing elective, unilateral, primary total hip (THA) and knee (TKA) arthroplasty for osteoarthritis from January 2016 to December 2019 were identified using a large national database. In-hospital postoperative complications, length of stay, and total costs adjusted for inflation in opioid + patients were compared with patients without chronic opioid use (OD). Logistic regression analyses were used to control for cofounding factors. OD patients undergoing either THA or TKA had a higher risk of postoperative complications including respiratory (odds ratio (OR): 1.4 and OR: 1.3), gastrointestinal (OR: 1.8 and OR: 1.8), urinary tract infection (OR: 1.1 and OR: 1.2), blood transfusion (OR: 1.5 and OR: 1.4), and deep vein thrombosis (OR: 1.7 and OR: 1.6), respectively. Total cost ($16,619 ±$9,251 versus $15,603 ±$9,181, P < .001), lengths of stay (2.15 ± 1.37 versus 2.03 ± 1.23, P < .001), and the likelihood for discharge to a rehabilitation facility (17.8 versus 15.7%, P < .001) were higher in patients with OD. OD was associated with higher risk for in-hospital postoperative complications and cost after primary THA and TKA. Further studies to find strategies to mitigate the impact of opioid use on complications are required

Increased Risk of In-Hospital Complications and Costs after Total Hip Arthroplasty for Primary and Secondary Osteonecrosis

An increasing proportion of patients are undergoing total hip arthroplasty (THA) for osteonecrosis (ON). Comorbid conditions and surgical risk factors are known to be greater in ON patients compared with patients who have osteoarthritis (OA) alone. The purpose of our study was to quantify the specific in-hospital complications and resource utilization associated with patients undergoing THA for ON versus osteoarthritis (OA). A large national database was queried to identify patients undergoing primary THA from January 1st 2016 to December 31st 2019. A total of 1,383,880 OA, 21,080 primary ON, and 54,335 secondary ON patients were identified. Demographics, in-hospital complications, costs, lengths of stay, and discharge dispositions for primary and secondary ON cohorts were compared to OA only. Age, race, ethnicity, comorbidities, Medicaid, and income status were controlled with binary logistic regression analyses. The ON patients were often younger, African American or Hispanic, and had more comorbidities. Those undergoing THA for primary and secondary ON had a significantly higher risk of peri-operative complications, including myocardial infarction, postoperative blood transfusion, and intraoperative bleeding. Total hospital costs and lengths of stay were significantly higher for both primary ON and secondary ON and both cohorts were less likely to be discharged home. While rates of most complications have decreased over recent decades in ON patients undergoing THA, the ON patients still have worse outcomes even when controlling for comorbidity differences. Bundled payment systems and perioperative management strategies for these different patient cohorts should be considered separately

Clinical Characteristics and Multisystem Imaging Findings of COVID-19: An Overview for Orthopedic Surgeons

The COVID-19 pandemic holds widespread implications for global public health, economies, societies, and the practice of orthopedic surgery. As our knowledge of the transmissibility of SARS-CoV-2 and the symptomatology and management of COVID-19 expands, orthopedic surgeons must remain up to date on the latest medical evidence and surgical perspectives. While COVID-19 primarily manifests with pulmonary symptoms, cardiovascular, neurologic, and other major organ systems may also be affected and present with hallmark imaging findings. This article reviews initial and emerging literature on clinical characteristics and imaging findings of COVID-19

Inhospital Complications and Costs of Simultaneous Bilateral Total Knee Arthroplasty: The Case for Selection and Potential Cost Savings

Published comparisons between bilateral and unilateral total knee arthroplasties (TKAs) remain biased, as most patients undergoing bilateral TKA are prescreened and healthier than average patients having unilateral procedures. Our objectives were to compare postoperative complications and resource utilization of patients having simultaneous bilateral TKAs with similar patients having unilateral procedures. The Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary elective TKA from 2002 to 2011. A total of 4,445,263 patients were identified. Of these, 190,783 (4%) were having same-day bilateral procedures. Patients with staged bilateral TKA during the same hospitalization were excluded. Complications and costs were compared to a matched cohort of patients having unilateral procedures. This cohort was matched based on age, gender, and 30 comorbid-defined elements in the NIS. A total of 172,366 (90%) simultaneous bilateral procedures were matched 1:1 to patients with unilateral procedures for the adjusted analysis. Patients with bilateral procedures were at an increased risk for many complications including postoperative anemia (OR: 2.3; 95% CI: 2.2-2.3, P < .001), cardiac (OR: 2.1; 95% CI: 2.0-2.3, P < .001), and inhospital mortality (OR: 3.3; 95% CI: 2.6-4.3). These patients also incurred in higher hospital costs ($19,343 vs$12,852, P < .001) and were discharged more commonly to a rehabilitation facility (70% vs 32%, P < .001). Patients undergoing simultaneous bilateral TKA are at an increased risk of developing important postoperative complications and mortality compared with unilateral cases. These data highlight the importance of patient selection and optimization for bilateral TKA and potential cost savings

Increased Morbidity With Diagnosis and Treatment of Pulmonary Embolism After Total Joint Arthroplasty: A Matched Control Analysis of 30,000 Patients

Currently, the risks associated with the diagnosis of pulmonary embolism (PE) and subsequent treatment are not well known. The purpose of our study is to quantify the specific in-hospital complications and resource utilization of patients with PE following total joint arthroplasty when compared to a matched cohort. The Nationwide Inpatient Sample database was used to identify patients undergoing primary hip and knee arthroplasty from January 1993 to December 2008. PE was determined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. In-hospital complications, costs, and length of stay for patients with PE were compared to patients without PE, matched on the basis of age, gender, procedure (total hip arthroplasty vs total knee arthroplasty), year of surgery, morbid obesity, and all 28 comorbid-defined elements of the Elixhauser Comorbidity Index. Of 8,634,038 procedures, 30,281 (0.4%) patients had a PE after total joint arthroplasty. In total, 29,917 (98%) were matched one-to-one with patients without PE. Patients with PE had a substantially higher risk of all postoperative in-hospital complications: deep vein thrombosis (odds ratio [OR] 17), peripheral vascular (OR 34), hematoma (OR 3.7), and gastrointestinal bleeding (OR 7.0) (all P < .001). Mortality was significantly higher in patients with PE compared to patients without PE (3.4% vs 0.1%, OR 30), along with total hospital costs, lengths of stay, and rates of discharge to rehabilitation facilities. After controlling for comorbidities patients with PE have a significantly higher risk for complications including in-hospital mortality and higher hospital costs when compared to patient without PE