Combination Of Defects Research Articles

Surface-disorder and cationic-site defect-induced ferromagnetism and correlated Raman vibrational modes in Sn0.9 In0.1O2 nanocrystalline thin-films

Exploration of magnetism in otherwise nonmagnetic wide-band oxides through defect-engineering has been become a new challenge to achieve the goal of room-temperature ferromagnetic semiconductor for potential applications in spintronics. In this backdrop, we report surface-disorder and cationic-site defect-induced FM in series of Sn0.9In0.1O2 nanocrystalline thin films prepared using pulsed laser deposition different Argon (Ar) pressure. With the increase of deposition pressure, surface morphology of Sn0.9In0.1O2 nanocrystalline thin-films changes as nanoclusters, nanofibres, nanoflakes and nanowires respectively, crystallite size decreases and surface disorder increases gradually. Raman, X-ray photoelectron and Photoluminescence spectroscopic analysis confirm the formation tin-vacancy (VSn) and associated combinational defects that significantly increase the ferromagnetic signal in In-doped SnO2 thin-films. The substitution of trivalent In3+ in Sn site also cause serious lattice distortion which transform the Raman inactive modes A2g and Eu modes into Raman active modes and thus appeared at 574 cm−1 and 354 cm−1 respectively. The nanowires of Sn0.9In0.1O2 are found to possess highest concentration of VSn defects and therefore it exhibits strongest ferromagnetic moment (MS) ∼ 11.1 emu/cm3 and highest Curie temperature (TC) ∼ 572 K. The gradual decrease in carrier concentration with the increasing deposition pressure suggests stabilization of hole-mediated VSn-induced room temperature FM in series of In-doped SnO2 nanocrystalline thin-films.

Treatment of Multiple Recessions Associated with Noncarious Cervical Lesions: A Case Series.

Gingival recessions with noncarious cervical lesions (NCCLs), also called combined defects, are common problems, and patients often seek treatment due to esthetic concerns or dentin hypersensitivity. This case series evaluates the effectiveness of the non-coronally advanced flap (CAF) technique combined with restorative treatment for Miller Class III gingival recessions with NCCLs. A total of 16 combined defects were included. The combined defect height (CDH), recession depth (RD), pocket depth (PD), keratinized tissue width (KTW), and presence of dentin hypersensitivity were recorded at baseline and 6 months postsurgery. The mean root coverage (mRC) was 83%, and 50% of defects presented complete root coverage (CRC). In the group with an initial KTW ≥ 2 mm, mRC and CRC were significantly higher. Further randomized controlled studies with larger sample sizes are needed to verify the prognostic factor of combined non-CAF techniques and restorative treatment for gingival recessions with NCCLs.

Evaluation of the level of damage to thermoplastic flat sheets of acrylonitrile butadiene styrene (ABS) subjected to static tensile tests using static and unified damage and estimation of service life

In this study, we are interested in the characterization of a flat plate in polymeric ABS under the uniaxial solicitation. We ran a series of tests on smooth rectangular specimens (defect-free) by ASTM 882-02 standards to characterize the material and provide a scale of comparison, as well as to investigate the combined defect effect on the mechanical behavior of ABS. Another panoply of tests was performed on rectangular test pieces with holes with a single notch and holes with a double notch. Then, we experimentally identify the propagation of their damage. The calculation of the damage, using models of experimental damage, led to determining the three stages of the evolution of the damage, which are the initiation, propagation, and complete deterioration of the material. Therefore, the approach of reliability (R) is a statical parameter, used to designate the critical life fraction concerning the notch depth (βc) of a modeled defect as a combined defect on an ABS specimen. In addition, the unified theory was developed in this context, on the one hand, to define the damage parameter, which is the internal variable that describes the state of damage of the structure in terms of the life fraction, and on the other hand for the theoretical re-evaluation of the level of damage. These techniques have the advantage of quickly assessing the performance and stability of the studied polymer and deciding whether to have an anticipatory maintenance strategy and an awareness of the safety requirements policy regarding the damage-reliability behavior of the studied specimens. From the latter, the discussion of the curves allowed us to maintain the limits of the ABS materials’ mechanical behavior and confirmed that the theoretical and experimental results show good agreement and correlation.

Automated defect recognition (ADR) for monitoring industrial components using neural networks with phased array ultrasonic images

In this paper, we propose a framework to automate the process of defect characterizing for industrial structural component health monitoring by implementing automatic defect recognition (ADR) system. The ADR system consists of a convolutional neural network (CNN) and an edge detection algorithm medial axis transform (MAT). The CNN learns the defect feature space from the training dataset to detect and classify the defect. The MAT algorithm is used upon post-validation of the ADR, and the predicted feature’s edges are extracted to size them. The ADR is trained using the simulation-assisted finite element (FE) simulation datasets consisting of side drilled holes (SDH) and crack defects images. The training datasets are generated by introducing virtual array source aperture (VASA), which is a full matrix capture (FMC) scanning strategy by activating the group of elements in an active aperture with predefined focal laws to form a focused beam at a virtual source in the material. The VASA technique uses multiple virtual sources and active aperture positions in a given transducer, which are determined using the Poisson point process. The ultrasound beam is excited in sequence on each virtual source, and the reflected wave is recoded using all the transducers in the array to create FMC A-scans signals. The total focusing method (TFM) technique is a postprocessing algorithm implemented on the FMC signal to generate an image. A large quantity of training datasets is created for each defect by modeling various FE models with varying defect morphology. To create nearly close to experimental images, the experimental noise is introduced in the simulated images. The three separate ADR systems are trained with individual defects class and combined defects. The effectiveness of the trained ADR system is validated by conducting experiments on the plates with laboratory-made SDH and crack defects, the casting components, and weldments with unknown defect types and sizes. The mAP of ADR training is 82%, and the F1-score on testing image classification is 89%. The ADR system could detect and size the smallest defect is 0.219 mm, which is λ L /5.

Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment.

Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options.

A tissue engineered 3D printed calcium alkali phosphate bioceramic bone graft enables vascularization and regeneration of critical-size discontinuity bony defects in vivo.

Introduction: Recently, efforts towards the development of patient-specific 3D printed scaffolds for bone tissue engineering from bioactive ceramics have continuously intensified. For reconstruction of segmental defects after subtotal mandibulectomy a suitable tissue engineered bioceramic bone graft needs to be endowed with homogenously distributed osteoblasts in order to mimic the advantageous features of vascularized autologous fibula grafts, which represent the standard of care, contain osteogenic cells and are transplanted with the respective blood vessel. Consequently, inducing vascularization early on is pivotal for bone tissue engineering. The current study explored an advanced bone tissue engineering approach combining an advanced 3D printing technique for bioactive resorbable ceramic scaffolds with a perfusion cell culture technique for pre-colonization with mesenchymal stem cells, and with an intrinsic angiogenesis technique for regenerating critical size, segmental discontinuity defects in vivo applying a rat model. To this end, the effect of differing Si-CAOP (silica containing calcium alkali orthophosphate) scaffold microarchitecture arising from 3D powder bed printing (RP) or the Schwarzwalder Somers (SSM) replica fabrication technique on vascularization and bone regeneration was analyzed in vivo. In 80 rats 6-mm segmental discontinuity defects were created in the left femur. Methods: Embryonic mesenchymal stem cells were cultured on RP and SSM scaffolds for 7d under perfusion to create Si-CAOP grafts with terminally differentiated osteoblasts and mineralizing bone matrix. These scaffolds were implanted into the segmental defects in combination with an arteriovenous bundle (AVB). Native scaffolds without cells or AVB served as controls. After 3 and 6months, femurs were processed for angio-µCT or hard tissue histology, histomorphometric and immunohistochemical analysis of angiogenic and osteogenic marker expression. Results: At 3 and 6months, defects reconstructed with RP scaffolds, cells and AVB displayed a statistically significant higher bone area fraction, blood vessel volume%, blood vessel surface/volume, blood vessel thickness, density and linear density than defects treated with the other scaffold configurations. Discussion: Taken together, this study demonstrated that the AVB technique is well suited for inducing adequate vascularization of the tissue engineered scaffold graft in segmental defects after 3 and 6months, and that our tissue engineering approach employing 3D powder bed printed scaffolds facilitated segmental defect repair.

Differentiated disorders of the immune system in acute hematogenic and acute posttraumatic osteomyelitis in children

Osteomyelitis is an inflammation of bone and bone marrow caused by the spread of S. aureus from a local focus by the hematogenous route or from an open traumatic fracture; it is difficult to treat and remains a serious problem. The condition for spreading of the infectious process into bone is the effect of S. aureus and its impaired elimination due to immune system (IS) dysfunction. Controversial information on the immunopathogenetic mechanisms of acute osteomyelitis needs study, which would allow the development of sound immunotherapy. Purpose of the study: to specify the variants of antibacterial immune protection disorders in children with acute hematogenous and acute posttraumatic osteomyelitis. Materials and methods. Children 8-15 years old (n = 22) were studied: Study Group 1 (SG1, n = 12) – with acute hematogenous osteomyelitis (AHO); Study Group 2 (SG2, n = 10) – with acute post-traumatic osteomyelitis (APTO). The comparison group (CG) – 13 healthy children. Tested: Tlymphocytes (CD3+CD19- , CD3+CD4+, CD3+CD8+), B lymphocytes (CD3- CD19+), NK (CD3- CD16+CD56+) and TNK (CD3+CD16+CD56+) lymphocytes, neutrophil granulocytes (NG, CD16, CD32, CD64) (FC-500 Beckman Coulter, USA); the level of serum IgA, IgM, IgG (ELISA). Phagocytic function of NGs in relation to S. aureus was assessed: the number of actively phagocytizing NGs (%PhAN), capture processes (PhN, PhI) and killing activity (%D, DI). Results. In both groups was revealed a decrease of T lymphocytes, T helpers, TCTL and NK quantity (p1-4 < 0.05). In AHO, the levels of IgA, IgM, IgG did not differ from that in GS, while in APTO the levels of IgA and IgG increased (p1, 2 < 0.05). The density of CD64, CD16, CD32 receptor expression on NG in the studied groups has been a different equipping, predetermining an incompetence of the phagocytic function: in AHO associated with abnormalities in the function capture and killing, in APTO only with the S. aureus digestion. Conclusion. The revealed combined defects of IS functioning necessitate the development of new approaches in the treatment of AHO and APTO in children, pathogenetically substantiating the use of immunotherapy in the complex etiopathogenetic treatment. This approach will contribute to the restoration of mechanisms of anti-infective immunity, timely elimination of pathogens, improve the clinical course of the diseases, prevent the chronic inflammatory process.

Introduction of temporomandibular joint and skull base combined reconstruction by autogenous bone graft.

This study introduces the application of autogenous bone graft for the reconstruction of temporomandibular joint (TMJ) and skull base combined defects. Patients treated with autogenous bone grafts for reconstruction of the TMJ and skull base were reviewed. All patients underwent virtual surgical design to confirm the osteotomies of the combined lesion and the selections of autogenous bone graft, fabrication of surgical templates to transfer the plan to actual operation, and reconstruction of autogenous bone graft for the TMJ and/or skull base. Surgical outcomes were assessed by clinical examinations and radiological data. Twenty-two patients were involved in this study. Ten patients underwent reconstruction of the skull base by a free iliac or temporal bone graft and preservation of the TMJ. Twelve patients underwent skull base reconstruction by the same methods and total reconstruction of the TMJ by half sternoclavicular joint flap or costochondral bone graft. No severe complications occurred after surgery. The occlusion relationship was stable and similar to that of the preoperative state. The pain and maximal interincisal opening were significantly improved by the 101.2-month follow-up. Autogenous bone graft is a good alternative for repairing the TMJ and the skull base structure and function. The study introduced the application of autogenous bone graft for the reconstruction of temporomandibular joint and skull base combined defect, which is a good way to repair the defect and restore the function.

A Rare Case: HaemoglobinS-Thalassemia in Adult

Hemoglobinopathy refers to a disease involving a qualitative or quantitative defect of the structure or synthesis of haemoglobin molecules. The HaemoglobinS- beta thalassemia occurs in a heterozygotes individual with beta-thalassemia and HaemoglobinS gene. A 29-year-old man came with severe anemia, thrombocytopenia, and history of repeated blood transfusions. Physical examination showed pale conjunctiva, pansystolic murmurs, and hepatosplenomegaly. The HaemoglobinS fraction was found in haemoglobin electrophoresis with increased HaemoglobinF and decreased HaemoglobinA2 fraction. The peripheral blood smear shows abnormal erythrocytes morphologies such as pencil shapes, fragmentocytes, target cells, and sickle shapes. The patient was diagnosed with chronic anaemia caused by HaemoglobinS-beta thalassemia. It makes ineffective erythropoiesis, intravascular, and extravascular hemolysis. This haemoglobinopathy caused increased ferritin and transferrin saturation. The presence of renal failure indicate there is a complicated condition like microvascular obstruction of renal. In this case, there is a reduction of HaemoglobinA2 fraction that is not common in HaemoglobinS-beta thalassemia. The patient with Haemoglobin S / beta+ thalassemia shows intravascular hemolysis, ineffective hematopoiesis, and vaso-occlusive signs. Deoxyribo Nucleic Acid analysis is further needed to confirm the combination defect of haemoglobin synthesis disorders in conjunction with alpha thalassemia or Hereditary persistence of fetal haemoglobin.

Personalized approach in the management of children with cardiorenal syndrome (combined congenital heart and kidney defects)

Today’s personalized medicine represents an integral model for the selection of diagnostic, therapeutic agents and preventive measures that are optimal for a particular individual, taking into account his genetic, physiological, biochemical, psychosocial and other characteristics.The presence of a special relationship between the cardiovascular system and the kidneys are confirmed by a significant difference in mortality from malformations and in the population. The possibility of prenatal diagnosis of malformations sets the task of a special approach to the management of such patients, which can provide a personalized approach.The article presents the experience of a personalized approach to the management of children with cardiorenal syndrome (combined congenital heart and kidney defects).

A Cartilaginous Construct with Bone Collar Exerts Bone-Regenerative Property Via Rapid Endochondral Ossification.

Three-dimensional clumps of mesenchymal stem cells (MSCs)/extracellular matrix (ECM) complexes (C-MSCs) can be implanted into tissue defects with no artificial scaffolds. In addition, the cellular properties and characteristics of the ECM in C-MSCs can be regulated in vitro. Most bone formation in the developmental and healing process is due to endochondral ossification, which occurs after bone collar formation surrounding cartilage derived from MSCs. Thus, to develop a rapid and reliable bone-regenerative cell therapy, the present study aimed to generate cartilaginous tissue covered with a mineralized bone collar-like structure from human C-MSCs by combining chondrogenic and osteogenic induction. Human bone marrow-derived MSCs were cultured in xeno-free/serum-free (XF) growth medium. Confluent cells that formed cellular sheets were detached from the culture plate using a micropipette tip. The floating cellular sheet contracted to round clumps of cells (C-MSCs). C-MSCs were maintained in XF-chondro-inductive medium (CIM) and XF-osteo-inductive medium (OIM). The biological and bone-regenerative properties of the generated cellular constructs were assessed in vitro and in vivo. C-MSCs cultured in CIM/OIM formed cartilaginous tissue covered with a mineralized matrix layer, whereas CIM treatment alone induced cartilage with no mineralization. Transplantation of the cartilaginous tissue covered with a mineralized matrix induced more rapid bone reconstruction via endochondral ossification in the severe combined immunodeficiency mouse calvarial defect model than that of cartilage generated using only CIM. These results highlight the potential of C-MSC culture in combination with CIM/OIM to generate cartilage covered with a bone collar-like structure, which can be applied for novel bone-regenerative cell therapy.

Influence of soft tissue elements on the reparative abilities of the jaw bone tissue

BACKGROUND: Treatment of patients with jaws bone defects requires the elimination of the defect, restoration of the dentition and long-term support of the functional state of the dental system. However, dental damages reduce the reparative capabilities of the jaw bone tissue. Therefore, when developing ways to optimize the reparative osteogenesis of such defects, an important task is to determine the proportion of soft tissue medium in the biology of a bone defect.
 AIMS: to study the effect of soft-tissue elements on the reparative abilities of jaw bone tissue.
 MATERIALS AND METHODS: The study included 98 people with acquired combined jaws bone defects. To study the tissue environment and the characteristics of the transformation of the tissues surrounding the defect, material was taken during the surgical intervention. The obtained samples were sent for histological examination.
 RESULTS: Microscopic examination of histological sections obtained from the area of jaws bone defects revealed the proliferation of a multilayer flat non-corneating epithelium with "creeping" and massive ingrowth of the epithelium into the area of the bone defect. The advance of the epithelium into the underlying bone led to atrophy and destruction of the bone over the entire area of the defect, an increase in the volume of the defect. The epithelial-connective tissue complex lined the bone surface of the defect, replacing the periosteum.
 CONCLUSIONS: The morphology of the tissues surrounding the area of the bone defect suggests a decrease in the sources of cambial bone elements. Treatment of jaws bone defects requires the elimination of the soft-tissue environment that fills the bone defect, followed by the operation of " Guided bone regeneration" using granular osteoconductive material and a resorbable collagen membrane.

The role of sperm DNA integrity in seminal plasma of infertile men

One-half of the genome is delivered by the sperm, and a healthy sperm is needed for fertilization, fetal development, and child wellbeing. Abnormal sperm DNA can impact any of these processes. The measurement of sperm DNA fragmentation has been added to some medical andrology laboratories as a crucial addition to the standard analysis of the semen. Sperm DNA fragmentation has also been linked to male infertility including idiopathic male infertility. Some degree of controlled DNA nicking is essential for adequate DNA compaction, but excessive sperm DNA fragmentation is usually associated with reduced male fertility potential, reduced fertilization, poor embryo quality, recurrent pregnancy loss and poor assisted reproductive techniques outcomes. Semen samples from 50 infertile males (as 19 asthenozoospermia, 7 oligozoospermia, 13 normospermia and 11 combined defects) were analyzed for sperm DNA fragmentation. This study followed the World Health Organization 2010 guidelines to assess the sperm parameters. Sample were collected by masturbation and put in a 37 °C incubator to be liquefied, then they were placed in a centrifuge (3000 rpm for 10 min) to extract the pellet, which was used for assessment of DFI% by anillin blue staining. Negative significant correlation (p = 0.023) between morphologically normal sperms and DFI % was found in normozoospermia group. The objective of this study is to examine the correlation of DFI among different seminal fluid categories (normozoospermia, oligozoospermia, asthenozoospermia and, combined).

The Results of Surgical Treatment of Patients with Many Valve Defects in Combination with Coronary Pathology

The objective: to analyze the impact of various surgical management on the duration of the ischemic period and the quality of myocardial protection during simultaneous combined correction of two-three heart valves and myocardial revascularization. Materials and methods. The results of the treatment of single-stage multivalve correction in combination with coronary artery bypass grafting in 93 patients, which was performed at the M.M. Amosov National Institute of Cardiovascular Surgery for the period from 2014 to 2021, were studied. Depending on the methods and the sequence of surgical manipulations, the patients were divided into three groups. I group – 42 patients who had the correction of heart valves firstly and then aortocoronary shunting in conditions of pharmaco-cold cardiac arrest, II group – 36 patients who first had aortocoronary bypass surgery, then valve correction in conditions of pharmaco-cold cardiac arrest, III group – 15 patients, who at the first stage had coronary artery bypass grafting on a working heart, then – correction of valve damage in conditions of pharmaco-cold cardiac arrest. Results. The use of the technique of primary restoration of coronary blood flow by shunting coronary arteries in a working heart before clamping the aorta (before pharmaco-cold cardiac arrest and the start of artificial blood circulation) allows to reduce the duration of artificial blood flow and ischemic time, which positively affects the heart rhythm in the postoperative period. Conclusions. The technique of performing aortocoronary shunting on a working heart is more effective than when performing aortocoronary shunting in conditions of pharmaco-cold cardiac arrest. This technique requires more time to perform and is technically more difficult, but it can statistically significantly reduce the time of myocardial ischemia, which reduces the frequency of severe heart failure and the frequency of postoperative complications.

Long-term stability of regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: 10-year data of a retrospective study.

To evaluate the long-term effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) in stage IV periodontitis. 22 patients with a total of 256 intra-bony defects were analyzed after regenerative surgery followed by OT initiated 3 months later. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1), final splinting (T2) and 10 years (T10). Mean rBL gain was significant with 4.63 mm (±2.43 mm) after 1 year (T1), 4.19 mm (±2.61 mm) at final splinting (T2) and 4.48 mm (±2.62 mm) after 10 years (T10). Mean PPD was significantly reduced from 5.84 mm (±2.05 mm) at baseline to 3.19 mm (±1.23 mm) at T1, to 3.07 mm (±1.23 mm) at T2 and to 2.93 mm (±1.24 mm) at T10. Pocket closure (PPD≤ 4mm) was achieved in 90% of all defects. Tooth loss amounted to 4.5%. Within the limitations of this retrospective study design, these 10-year findings suggest that in motivated and compliant patients with stage IV periodontitis and in need of orthodontic therapy an inter-disciplinary treatment can lead to favorable and stable long-term results. This article is protected by copyright. All rights reserved.

Treatment of multiple valve disease: surgery, structural intervention, or both?

Multiple valve heart disease refers to the simultaneous presence of several valvular anomalies, while mixed valvular heart disease refers to the combination of stenotic lesions or regurgitation affecting the same valve. The pathophysiology of multiple and mixed valvular heart disease depends on the combination of affected valves and the severity of the individual valvular defects. Imaging is essential for diagnosis and assessment of disease severity. The treatment of combined valvular defects currently represents a challenge for both cardiac surgeons and interventional cardiologists since only few data in the literature address the clinical and therapeutic decision-making process related to these complex lesions. These are heterogeneous conditions, which differ from each other in the combination of the valves involved, in the pathogenesis with which they develop, in the severity of the individual lesions, in the associated surgical risk, in the possibility of being repaired, and in the undergoing transcatheter treatments. In addition to the severity of the individual valve defects, the choice of treatment also depends on the ventricular function and the general condition of the patient. This work aims to provide a review of the state of the art regarding the possible management strategies of the most common multiple valve diseases in clinical practice.

TREATMENT OF VERY LARGE TRAUMATIC BONE DEFECTS WITH A BIODEGRADABLE POLYCAPROLACTONE-TRICALCIUM PHOSPHATE 3D-PRINTED SCAFFOLD: A REVIEW OF THREE CLINICAL 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 remains high. This paper describes three infected tibial defect nonunions with a segmental defect over ten centimeters long treated with a customized 3D printed polycaprolactone-tricalcium phosphate (PCL-TCP) cage in combination with biological adjuncts.Three male patients, between the age 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 ten centimeters (range 11–15cm). First stage MPs consisted of extensive debridement, external fixation and placement of anterior lateral thigh flaps (ALT). Positive cultures were obtained from all patients during this first stage, that were treated with specific systemic antibiotics during 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 6 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 is a novel addition to the surgical treatment of very large bone defects in (infected) posttraumatic nonunion of the tibia. This combination could overcome some of the current drawbacks in this challenging indication.

Анализ окклюзиографии у пациентов пожилого возраста с различными типами дефектов зубных рядов

INTRODUCTION: Dentistry is one of the most actively developing medical sciences. New concepts and approaches to dental care, comprehensive diagnosis of dental diseases are annually presented at scientific congresses and conferences of various levels. However, a number of traditional methods and approaches to comprehensive diagnosis of the dentoalveolar system remain relevant to this day. The presented article is devoted to the assessment of the relevance and practical application of the occlusiography technique in elderly patients with dentition defects of various extensions. AIM: Determination of occlusiography in elderly patients with various types of dentition defects, and its analysis. MATERIALS AND METHODS: This study is based on the determination and analysis of occlusion-graphy in elderly patients. A total of 150 patients were included in the study, who were divided into three groups. Group 1 — patients with terminal defects (unilateral and bilateral). Group 2 — patients with included defects (unilateral and bilateral). Group 3 — patients with combined defects (terminal and included). There were 50 patients in each group. Computer occlusiography and traditional occlusiography were performed. A proprietary method was used – a program of photographic morphometric analysis of control-diagnostic models. RESULTS: In group 1, high dependence of the results of the proprietary method of digital analysis of occlusiogram on the quality of the photo image was revealed. Due to the absence of a chewing group of teeth, the area of occlusal contact of incisors and canines was considered insignificant. The obtained results revealed a high chewing load on the frontal group of teeth with the absence of chewing teeth. Most of the occlusal contacts led to a complete loss of the wax layer on the occlusiogram. In the 2nd study group, with the presence of teeth limiting the defect, the tightness of occlusal contacts permitted to obtain a true occlusiogram. As a result, 75% of respondents had a small number of supracontacts, 93% of the subjects had supracontacts within the teeth limiting the defect of the dentition. With this, the preserved teeth helped obtain a high-quality imprint of the occlusal relief on an analog wax plate, which permitted to obtain the maximum similarity of the results of the proprietary method and of T-scan computer system (90%). In group 3, the wax template was additionally reinforced with occlusive wax in the area of the terminal defect of the dentition. In 85% of patients, supracontacts were located in the area of dentition defects, significant disorders of the position of the teeth limiting the terminal defect were noted. The reason for this may be vertical loads during chewing. In this group, the average deviation of the results of analog occlusiography from those of the digital one was 87.5%. CONCLUSIONS: It is recommended that occlusiography be used at the stage of diagnosis in all dental specialties.

Patterns of glenoid bone loss in revision of anatomic shoulder arthroplasty: the impact of prior glenoid resurfacing

BackgroundHistorically, glenoid resurfacing has been avoided in the young patient due to a perceived risk of early glenoid loosening and destructive bone loss. As a result, many young patients with end-stage arthritis undergo humeral-based hemiarthroplasty with subsequent incomplete pain relief. The aim of this study was to determine the status of glenoid bone stock in patients undergoing revision of a painful hemiarthroplasty versus anatomic total shoulder arthroplasty (aTSA). MethodsUsing an institutional shoulder arthroplasty revision database, all patients undergoing revision for aseptic glenoid-based pain after hemiarthroplasty or glenoid loosening of aTSA were identified. Patient demographics, implant longevity prior to revision, and implanted construct at revision were collected for each patient. Based upon preoperative plain films, computed tomography when available, and intraoperative documentation, the status of the glenoid bone stock was described. ResultsA total of 39 patients (14 aTSA and 25 hemiarthroplasty) met the inclusion criteria. No statistically significant difference in age at the time of index arthroplasty (56.4 vs. 52.4 years; P = .18), age at time of revision (64.5 vs. 59.0 years; P = .07), proportion of males (64.2% vs. 56.0%; P = .74), or longevity of the revised implant (110.9 vs. 79.2 months; P = .08) were identified between the aTSA and hemiarthroplasty cohorts, respectively. Patients undergoing revision of aTSA were more likely to receive a reverse total shoulder arthroplasty at revision (85.7% vs. 48%; P = .04). Peripheral wear alone was noted in 40% (10/25) of hemiarthroplasty revisions and central defect alone was noted in 79% (11/14) of aTSA revisions. Combined defects (central and peripheral bone loss) were noted in three patients undergoing revision of an aTSA (21.4%) and five undergoing revision of a hemiarthroplasty (20%; P = 1.0). The number of cases with medialization at or beyond the coracoid (Kocsis Grade 2; 42.9% vs. 40%) and at or beyond the spinoglenoid notch (Kocsis Grade 3; 14% vs. 12%) was not different between groups (P = 1.0). Structural bone graft or augmented glenoid components were used at the time of revision in 29% (4/14) and 32% (8/25) of failed aTSA and hemiarthroplasty, respectively (P = 1.0). ConclusionDespite variability in the cohorts, this study demonstrates no significant improvement in residual glenoid bone stock by deferring glenoid resurfacing at the time of shoulder arthroplasty. At the time of glenoid-based failure, glenoid resurfacing results in central bone loss while hemiarthroplasty results in peripheral/eccentric bone loss.

Predictors of Bone Loss in Anterior Glenohumeral Instability

Background: Anterior shoulder instability can result in bone loss of both the anterior glenoid and the posterior humerus. Bone loss has been shown to lead to increased failure postoperatively and may necessitate more complex surgical procedures, resulting in worse clinical outcomes and posttraumatic arthritis. Hypothesis/Purpose: The purpose of this study was to investigate predictors of glenoid and humeral head bone loss in patients undergoing surgery for anterior shoulder instability. It was hypothesized that male sex, contact sport participation, traumatic dislocation, and higher number of instability events would be associated with greater bone loss. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 892 patients with anterior shoulder instability were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. The presence and amount of anterior glenoid bone loss and accompanying Hill-Sachs lesions were quantified. Descriptive information and injury history were used to construct proportional odds models for the presence of any bone defect, for defects >10% of the anterior glenoid or humeral head, and for combined bony defects. Results: Anterior glenoid bone loss and Hill-Sachs lesions were present in 185 (20.7%) and 470 (52.7%) patients, respectively. Having an increased number of dislocations was associated with bone loss in all models. Increasing age, male sex, and non-White race were associated with anterior glenoid bone defects and Hill-Sachs lesions. Contact sport participation was associated with anterior glenoid bone loss, and Shoulder Actitvity Scale with glenoid bone loss >10%. A positive apprehension test was associated with Hill-Sachs lesions. Combined lesions were present in 19.4% of patients, and for every additional shoulder dislocation, the odds of having a combined lesion was 95% higher. Conclusion: An increasing number of preoperative shoulder dislocations is the factor most strongly associated with glenoid bone loss, Hill-Sachs lesions, and combined lesions. Early surgical stabilization before recurrence of instability may be the most effective method for preventing progression to clinically significant bone loss. Patients should be made aware of the expected course of shoulder instability, especially in athletes at high risk for recurrence and osseous defects, which may complicate care and worsen outcomes. Registration: NCT02075775 (ClinicalTrials.gov identifier).