Complete Insertion Research Articles

Bilayer Dissolving Microneedles Incorporating Hypericin-Loaded Nanocapsules For Improved Localised Photodynamic Therapy

Hypericin (Hy) is a potent lipid-soluble photosensitizerhaving broad pharmacological spectrum. Nevertheless, its poor water solubilityleads to its aggregation in the biological systems that consequently diminishesits photodynamic activity (PDA) and its therapeutic applications. Therefore,this study presents novel hydro-solving bilayer microneedle (MN) arraysincorporating Hy-loaded lipid nanocapsules (LNC) to prevent drug aggregation,enhance its delivery and local PDA. The Hy-LNC were prepared by phase inversiontechnique and showed homogenous particle size distribution and highencapsulation efficiency (88.42 ± 0.11%). The bilayer MNs consist of a hydrogelcross-linked, drug-free base plate and a Hy-loaded MN for a one-stepapplication. The dissolving MNs were fabricated from aqueous blends of 10% w/wpolyvinyl alcohol and 30% w/w polyvinyl pyrrolidone by casting and pressure.The MN arrays were characterized for mechanical strength and insertion depth.The bilayer arrays showed good mechanical strength under a compression force of32 N, with a height reduction of 10.14 ± 0.55% and sufficient insertion depthin both Parafilm M® and the excised porcine skin. After 2h of application toexcised pig skin, the MNs were completely dissolved ensuring the delivery ofits payload and the base plate was removed intact free from MN residuals. Inconclusion, the incorporation of Hy-LNC into this novel bilayer MNs overcomeits aggregation and ensured the complete insertion of the drug-loaded MNs. ThisLNC-MN system is promising for improving Hy local availability and thusenhancing its photodynamic application.

Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays.

To evaluate the hearing preservation (HP) in cochlear implant (CI) recipients who did not fulfill the criteria for electric acoustic stimulation (EAS). Prospective study SETTING:: Tertiary academic hospital. Adults undergoing CI with deep insertion electrode arrays who had measurable residual hearing (RH) before surgery. Demographic data, surgical technique, pure-tone average, and radiological findings were evaluated. Pre- and postoperative pure-tone audiometry. A preservation study was therefore performed for the whole range of frequencies (THP), and for low frequencies (LFHP). From the total 25 patients who underwent the surgical procedure, 6 of them (26.08%) did not retain any RH and 17 of them (73.91%) had some degree of HP. A clear association was observed between the use of the atraumatic technique (AT) and the percentage of some degree of HP. In patients who underwent the AT, LFHP was 72.79% and THP was 70.40%. In patients who did not undergo the technique, LFHP was 31.48% (p: 0.003) and THP was 23.50% (p: 0.002). LFHP was complete or partial (more than 25% of initial RH) in 92.3% of patients who underwent AT and in 50% of those who did not. Radiological findings showed that complete insertion is not associated with poorer HP. If the appropriate technique is used, preservation of RH is feasible after cochlear implant surgery with deep insertion electrode arrays.

Shallow-Depth Insertion: Peg in Shallow Hole Through Robotic In-Hand Manipulation

This letter presents a novel robotic manipulation technique suitable for shallow-depth insertion , which refers to the assembly of a relatively thin peg-like object into a hole with a shallow depth, as can be seen in a cell phone battery insertion for example. Our technique features dexterous manipulation actions that combine into a complete insertion operation, as also commonly demonstrated by humans performing the battery insertion task. The quasistatic stability of the presented insertion process is shown by constructing the space of force-closure grasps and manipulation primitives to navigate the space by changing the grasps. Our technique is directly applicable to a simple hardware setting with the conventional parallel-jaw gripper installed on an industrial robot arm. A set of experiments performed with our software demonstrates the effectiveness of our technique with a high success rate.

Analytical and experimental investigation of puncture-cut resistance of soft membranes

Modeling and evaluating critical puncture-cutting force and total applied energy are among the most important steps in characterizing the resistance of protective materials to sharp-tipped object insertion. This paper explores the relationship between these two mechanical properties, force and energy, corresponding to the insertion of a pointed blade into soft membranes. The paper’s main contribution includes the addition of friction energy to the existing analytical cutting model in order to develop a more comprehensive model. This energy is provided by the normal stress (contact pressure) caused by the created fracture surface. The contact pressure is applied on both lateral sides of the pointed blade. In this work, a model describing the combined puncture and cutting of protective materials is developed using force distribution analysis and basic concepts of fracture mechanics. Results show that the critical puncture-cutting force (FP/C) required for complete insertion of a pointed blade decreases with the increase of the puncture-cut ratio, ζ, given by the shape of the pointed blade. In other words, the puncture cutting of soft membranes is easier when the pointed blade has a high cutting edge angle than when it has a small cutting edge angle. Fracture mechanics theory is then used to determine the relationship between FP/C and the total puncture-cutting energy, GTotal, that includes fracture toughness of material and friction energy. The presented model is verified by comparing the predicted values of FP/C with experimental data obtained from puncture-cutting tests of soft elastomeric materials and soft-coated fabrics by three pointed blades. According to the proposed model, the methods corresponding to force measurement (FP/C) or energy calculation (GTotal) are both able to evaluate accurately the puncture-cut resistance of protective materials by any sharp-tipped objects.

Structural equation modeling of the impact of mandibular ridge form and denture quality on oral health-related quality of life in complete denture wearers

PurposeTo examine the effect of mandibular ridge form and denture quality on oral health-related quality of life (OHRQoL) in complete denture wearers by using structural equation modeling (SEM) analysis of data before and after new complete denture insertion. MethodsFour hundred thirty-two edentulous patients who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. An intervention study design was conducted, including complete denture fabrication with SEM analysis. Mandibular ridge form, mandibular denture stability, accuracy of jaw relation record, and the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J) total score before and after new complete denture insertion were used in the hypothesized model. ResultsTwo hundred and thirty-seven participants completed the research. SEM analysis demonstrated adequate model fit. Path coefficients of mandibular ridge form to OHIP-EDENT-J before and after insertion, and mandibular denture stability to OHIP-EDENT-J before insertion, were significant. ConclusionsThis study demonstrated that mandibular denture stability and mandibular ridge form are important to ensure successful complete denture therapy.

Cochlear Implant Users with Otosclerosis: Are Hearing and Quality of Life Outcomes Worse than in Cochlear Implant Users without Otosclerosis?

Background: The otosclerotic process may influence the performance of the cochlear implant (CI). Difficulty in inserting the electrode array due to potential ossification of the cochlea, facial nerve stimulation, and instability of the results are potential challenges for the CI team. Objectives: To evaluate hearing results and subjective outcomes of CI users with otosclerosis and to compare them with those of CI users without otosclerosis. Method: Retrospective review of 239 adults with bilateral profound postlingual deafness who underwent unilateral cochlear implantation between 1992 and 2017. Hearing and speech understanding were assessed via pure-tone audiometry and speech perception tests. Subjective outcomes were assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), and the Hearing Implant Sound Quality Index (HISQUI₁₉) at 6 months, 12 months, and at the last follow-up. Results: Subjects were 22 CI users with otosclerosis and 217 without otosclerosis. Both groups had a similar duration of deafness and age at CI implantation. Results did not significantly differ according to group: no significant intergroup difference was found regarding the frequency of complete electrode insertion, facial stimulation, reimplantation, or PTA4 scores at the last follow-up. Regarding speech perception, no significant intergroup difference was found on any test or at any interval. Further, subjective outcomes, as measured by the GBI, NCIQ, and HISQUI₁₉, did not significantly differ between groups. Conclusions: Adults with otosclerosis and profound hearing loss derive significant benefit from CI use. Audiological and self-reported outcomes are not significantly different from that of other CI users with postlingual deafness.

A comparative evaluation of border molding using two different materials in mandibular edentulous arches- an in-vivo study

Brief Background The purpose was to compare and evaluate border moulding using two different materials on mandibular edentulous arches. Materials and Methods This clinical study was performed on 15 healthy edentulous subjects who reported to the department of Prosthodontics. All the subjects were first given complete dentures, fabricated with low fusing compound as the border moulding material, followed by complete dentures with putty as the border moulding material. Retention was measured at 3 stages: Border moulding; Complete denture insertion; 6 weeks follow up. Patient’s satisfaction was measured with a 10 point visual analogue scale for both the dentures pre treatment and at the follow up visit. Results Putty border moulding showed higher retention as compared to low fusing compound border moulding with significant difference at all stages- stage 1 (p=0.011), stage 2 (p=0.009) and stage 3 (p=0.0054). The time taken for border moulding was significantly lower in Group 2 than Group 1(P=1.6E-48). According to VAS scores, in terms of aesthetic and comfort parameters, patients were satisfied in both groups without any significant difference, however, retention in Group 2 was higher as compared to group 1(P=0.05) Summary and Conclusions There was a statistically significant difference in the retention, between the groups. Group 2( Putty) had higher retention compared to Group 1(low fusing compound).Time taken for border moulding was significantly lower for Group 2( putty). No significant difference in patient’s satisfaction was observed for aesthetic and comfort parameters. In functional parameter, retention was better in Group 2(putty) subjects. Key Words: Low fusing compound, PVS (putty), border molding, mandibular edentulous arch.

Determination of Salivary Myeloperoxidase, Immunoglobulin E, and Tumor Necrosis Factor-α after Complete Denture Insertion

Objective: To detect activities of salivary myeloperoxidase (MPO) and concentrations of salivary tumor necrosis factor (TNF)-α as indicators of inflammatory reaction and salivary immunoglobulin E as an indicator of allergic reaction after complete insertion of acrylic dentures. Subjects and Methods: Complete dentures were made for a uniform group of elderly patients, and saliva samples were taken immediately before they were given to the patients, as well as 2, 3, 7, and 30 days after insertion of the dentures, with simultaneous monitoring of changes in the oral mucosa. Results: After 7 and 30 days of wearing upper and lower complete dentures, nonsignificant increases in salivary MPO and TNF-α were proven to be indicators of inflammation. No changes were observed in the values of salivary immunoglobulin E during a 30-day observational period, which excluded the appearance of allergic reactions to acrylic materials in the tested group of patients. Conclusion: A nonsignificant increase in the levels of MPO was observed on day 7; it decreased after 30 days. TNF-α also tended to increase in a nonsignificant manner.

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy.

Cochlear implantation in patients with ossified cochleas.

The timing of CI for postmeningitic deafness is controversial and differential outcomes have been reported. To review and share our surgical and auditory outcomes. 17 patients with ossified cochleas who received CI were enrolled. Clinical data including the cause of cochlear ossification, preoperative examination, onset of deafness, age at implantation, surgical findings, and relevant auditory outcomes was analysed. Cochlear ossification was observed in 53% of patients with HRCT, whereas the corresponding value for MRI was 59%. Patients in both stage I and II received complete insertion of the electrode array, however, stage III patients only received partial insertion. 1 patient in stage II received bilateral CI. Hearing tests showed increased average hearing threshold for stage III patients than those in stage I and II (P < 0.05). CAP scores were much lower for stage III patients than those in stage I and II (P < 0.05). Postlingual deafness patients showed higher SIR scores than prelingual deafness children (P < 0.05). HRCT and MRI have comparable value in predicting the occurrence of ossification in cochleas. We recommend fast surgical intervention in the patients with bilateral profound postmeningitic deafness. If possible, bilateral cochlear implantation is recommended.

Cochlear implantation after canal wall down mastoidectomy — Outcomes after partial mastoid obliteration

ObjectiveTo describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures. MethodsOut of 1020 patients undergoing cochlear implantation between January 1st, 2003 and June 15th, 2016 at the Department of Otolaryngology, Head & Neck Surgery, University Hospital Cologne, eight patients underwent obliteration of the radical cavity prior to cochlear implantation. In four additional patients, the external ear canal was overclosed prior to cochlear implantation. ResultsPatients undergoing partial mastoid obliteration (five ♀, 4 left ears) and overclosure of the external ear canal (one ♀, 3 left ears) averaged 56years and 61years, respectively. The radical cavities had been present for 21.8years on average before partial obliteration and for 19.5years before overclosure. Cochlear implantation following mastoid obliteration was performed after a mean period of 5.1months and 3.8months after overclosure. After partial mastoid obliteration, complete insertion of all electrodes was achieved and the clinical courses were uneventful for all patients. Likewise, no patient revealed any complications after overclosure of the external ear canal. ConclusionPartial mastoid obliteration with bone paté and cartilage after canal wall down mastoidectomy can be advocated as a feasible alternative technique that allows for a safe subsequent cochlear implantation.

Inter-rater and intra-raters' variability in evaluating complete dentures insertion procedure in senior undergraduates' prosthodontics clinics.

BackgroundDirect clinical assessment is the mainstay of evaluation in dentistry education. An effective evaluation method in prosthodontics should be equally valid and consistent; however, this is not attained frequently. A limited number of studies have applied an analytic evaluation in prosthodontics.ObjectiveTo compare the intra- and inter-raters’ variability in two evaluation methods: glance and grade (global), and checklist and criteria (analytical). Moreover, to identify the components of the analytical evaluation system and its applicability.MethodsThis cross-sectional study was carried out on outpatients attending removable prosthodontics clinics affiliated with King Abdulaziz University (Jeddah, Saudi Arabia) from December 2017 to April 2018. Two prosthodontist examiners evaluated a sample of 35 complete denture cases (20 male, 15 female) twice over a period of five months. Inter-rater and intra-rater agreement were computed using reliability test (interclass correlation coefficient ICC). Data were analyzed in IBM SPSS version 23, using paired-samples t-test, weighted kappa, and Wilcoxon signed-rank test. The level of significance was set at p≤0.05.ResultsThe intra-rater agreement for the first and second exposures under global and analytical evaluation methods with Examiner A was outstanding with 90.7% and 99.8% agreement respectively. While with Examiner B, global was lower but still in the acceptable range with about 78.1%, and 96.1% for the analytical evaluation. Inter-rater reliability analysis showed high agreement between the two raters in the first exposure of the analytical evaluation with 97.3%, while it was 87.5% in the global evaluation. This trend goes the same with analytical in the second exposure with 93.2%; however, the second exposure under global evaluation failed the cut off, which is only 56.6% agreement. In evaluation of inter-raters agreement, the second exposure of the global method demonstrated inconsistency between the two examiners (p=0.002), while the analytical second exposure demonstrated more homogeneity (p=0.050). Intra-rater variability between first and second exposure in analytical evaluation was (0.711 for the first rater and 0.677 for the second rater). Intra-rater variability between first and second exposure in global evaluation was (<0.001 for the first rater and 0.075 for the second rater).ConclusionA simple objective and detailed method to evaluate complete denture insertion procedure was developed, and it showed that both intra-rater and inter-rater agreement were excellent for the analytical method that might overcome errors and subjectivity in evaluation that result from the limitations of global method. Results recommend suitability of using the analytical evaluation to improve reliability between raters.

An Optimized Robot-Based Technique for Cochlear Implantation to Reduce Array Insertion Trauma.

To compare the intracochlear trauma induced by optimized robot-based and manual techniques with a straight electrode array prototype inserted at different lengths. Experimental study. Robot-based otologic surgery laboratory. A prototype array was inserted at different insertion lengths (21 and 25 mm) in 20 temporal bones. The manual insertion was performed with a microforceps. The optimized approach consisted of an optimal axis insertion provided by a robot-based arm controlled by a tracking system, with a constant speed of insertion (0.25 mm/s) achieved by a motorized insertion tool. The electrode position was determined at the level of each electrode by stereomicroscopic cochlea section analysis. A higher number of electrodes correctly located in the scala tympani was associated with the optimized approach ( P = .03, 2-way analysis of variance). Regardless of the insertion technique used, the array inserted at 25 mm allowed complete insertion of the active stimulating portion of the array in all cases. Insertion depth was greater when the array was inserted to 25 mm versus 21 mm ( P < .001, 2-way analysis of variance). The optimized insertion was associated with less trauma than that from manual insertion regardless the length of the inserted array ( P = .04, 2-way analysis of variance). Compared with a manual insertion, intracochlear trauma could be reduced with array insertion performed on an optimal axis by using motorized insertion and by applying a constant insertion speed.

Assessment of the Effect of Complete Denture Adhesives on Oral Epithelial Cells’ DNA in Elderly Patients with Controlled Diabetes

Aim of the study: Denture adhesives have long been recognized by denture wearers as a valuable assistant to denture retention and stability especially for patients reporting dissatisfaction with conventional dentures as diabetic patients. There is no available guide to select the proper adhesive form with least effect on oral mucosa. This clinical study assessed the impact of different complete denture adhesive forms on oral epithelial cells’ DNA in elderly patient with controlled diabetes.Materials and Methods: Fifteen completely edentulous controlled diabetic patients were selected and complete dentures were constructed. After two weeks of complete denture insertion, patients were prescribed with denture adhesives for another two weeks. According to the used adhesive form, patients were divided into three equal groups; group (I) used denture adhesive paste, group (II) used denture adhesive powder, where group (III) used denture adhesive cushion. The maxillary alveolar mucosae of all patients were swabbed to collect epithelial cells before denture insertion, two weeks after wearing the denture and two weeks after adhesive application. DNA analysis was carried out for the swabbed epithelial cells. The percentage of Genomic Template Stability (GTS %) was assessed and compared for all patients at various time intervals. Results: Genomic Template Stability decreased significantly in all patients two weeks after denture insertion while, significant increase in GTS% was observed two weeks after denture adhesives application. Cushion adhesive showed a significant increase in GTS% compared to paste and powder adhesives. Conclusion: Genomic Template Stability of controlled diabetic denture wearers improved when paste, powder or cushion adhesives were used. Cushion adhesive had a better effect on GTS% compared to paste or powder adhesives.

Cochlear Implant in Prelingually Deaf Children: Our Experience.

Retrospective study of the prelingual cochlear implantation programme under government scheme done at medical college hospital in central India. Forty-two prelingually deaf children screened and sent for cochlear implantation at our centre From March 2015 to Feb 2018 were reviewed with respect to their age, sex, preimplantation hearing aid use, surgical technique for cochlear implantation, type of FDA (USA) approved cochlear implant, post operative speech therapy and its outcome with respect to categories of auditory perception and speech intelligibility scoring were compared for children younger than 4years and older than 4years. For outcome measurement non parametric statistical method was used for any significance between the two groups. There was a wide range of children implanted ranging from 2 to 7years. Both varia and mastoidectomy and posterior tympanotomy method of cochlear implantations were done with good rate complete insertion and electrode activation. There was no significant difference between the two group with regard to CAP and SIR outcomes after 1year. In order to get better outcomes with respect to the speech language development, there is need to strengthen the early identification and cochlear implantation before 4years of age in government approved schemes.

Case Study: Cardiac sarcoidosis resolved with Mycobacterium avium paratuberculosis antibiotics (MAP).

Background: The author presents a clinical history and personal case study following his diagnosis of inactive sarcoidosis in 2004, followed by an acute episode of cardiac sarcoidosis (CS) in 2012 which resulted in complete heart block, cardiac myopathy, heart failure and insertion of an implantable cardioverter defibrillator (ICD) pacemaker. Methods: Following a detailed review of the clinical and scientific literature he concluded that sarcoidosis may be a mycobacterial infection and could be treated with anti-MAP antibiotic regime (1) developed to treat Crohn's disease. Findings: After successful culture and identification of viable MAP in his blood, treatment with the MAP antibiotic regime for one year led to complete metabolic resolution of the previously avid cardiac sarcoidosis and no PET evidence of any metabolically active sarcoidosis anywhere. Such reversal of cardiac sarcoidosis has never previously been reported. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 171-177).

Salivary Microflora of Complete Denture Wearing Patients

Objectives of this study were to see the types of aerobic microorganisms present in the saliva of Complete Denture wearing patients and to see any change in isolation frequency and types of microorganisms at 1-week of dentures in use. Materials and Methods: Ethical clearance from the institutional ethical committee and written consent from the patients were taken. All the patients were assessed by taking a detailed history and clinical examination which were recorded in the pre-designed proforma. Standard procedures accepted in the Department of Prosthodontics and in the Department of Microbiology were performed. Each patient were examined twice, once at 24hrs of denture insertion and then at 1-week of dentures in use. A micropippet was used to collect the resting saliva from the floor of the mouth and was diluted in 1ml of normal saline in a sterile vial and was immediately taken to the microbiology lab for culture within half an hour of sample collection. Result: Microorganisms identified at 24hrs of Complete Denture insertion were Streptococcus spp. (n=35), Staphylococcus spp. (n=15), Klebsiella pneumonia (n=5), Acinetobacter anitratus (n=5), Enterobacter cloacae (n=4), Citrobacter freundii (n=4), Pseudomonas aeruginosa (n=1) and Proteus vulgaris (n=1). Two new microorganisms were isolated at 1-week, Escherichia coli (n=1) and Candida albicans (n=2). Frequency of isolation of the gram negative bacteria increased at 1-week except for Proteus vulgaris. Conclusion: Use of Complete Denture favours colonization of some microorganisms which appear in saliva of patients.

Silicon-Based Microfabrication of Free-Floating Neural Probes and Insertion Tool for Chronic Applications.

Bidirectional neural interfaces for multi-channel, high-density recording and electrical stimulation of neural activity in the central nervous system are fundamental tools for neuroscience and medical applications. Especially for clinical use, these electrical interfaces must be stable over several years, which is still a major challenge due to the foreign body response of neural tissue. A feasible solution to reduce this inflammatory response is to enable a free-floating implantation of high-density, silicon-based neural probes to avoid mechanical coupling between the skull and the cortex during brain micromotion. This paper presents our latest development of a reproducible microfabrication process, which allows a monolithic integration of a highly-flexible, polyimide-based cable with a silicon-stiffened neural probe at a high resolution of 1 µm. For a precise and complete insertion of the free-floating probes into the cortex, a new silicon-based, vacuum-actuated insertion tool is presented, which can be attached to commercially available electrode drives. To reduce the electrode impedance and enable safe and stable microstimulation an additional coating with the electrical conductive polymer PEDOT:PSS is used. The long-term stability of the presented free-floating neural probes is demonstrated in vitro and in vivo. The promising results suggest the feasibility of these neural probes for chronic applications.

Management of advanced otosclerosis: experience in a tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Advanced otosclerosis affects approximately 10% of patients with otosclerosis. Ossification of the cochlea increases with the course of the disease and may cause sensori-neural or mixed hearing loss. Hearing aids, stapedotomy and cochlear implants are management options for hearing loss associated with advanced otosclerosis. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A retrospective study of 153 patients with advanced otosclerosis was done in a tertiary ENT centre. 110 patients with advanced otosclerosis underwent stapedotomy and 43 patients with advanced otosclerosis underwent cochlear implantation (CI) from 1997 till date. Exclusion criteria included patients with profound hearing loss from causes other than otosclerosis. The aim was to study the indications, selection criteria, as well as surgical issues of stapedotomy and cochlear implantation in patients with advanced otosclerosis. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Stapedotomy followed by use of hearing aid was found to give good outcomes in advanced otosclerosis. Patients with advanced otosclerosis who had poor pre-operative speech discrimination underwent CI. Complete insertion was possible in 39 patients and partial insertion was done in 4 patients. The outcomes of cochlear implantation were found to be satisfactory. Facial nerve stimulation was seen in 5 patients who underwent CI; however this was successfully managed by reprogramming or switching off the concerned electrodes. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our experience, stapedotomy or CI in advanced otosclerosis has proven successful, with a low complication rate. The selection criteria for stapedotomy versus CI have to be stringent for optimal outcomes.&lt;/span&gt;&lt;/p&gt;

The Insertion of Carbon Dioxide in Combination with RNCS (R Is Et, Ph) or N,N′-Dihexylcarbodiimide into the Re–O(R) Bonds

The heteromolecular insertion of carbon dioxide in combination with heterocumulenes, iso(thio)cyanates or N,N′-dicyclohexylcarbodiimide, into rhenium–alkoxy group bond was accomplished for the first time in relation to reactivity of rhenium oxoalkoxides. The ease of combined insertion of iso(thio)cyanate and carbon dioxide into Re–O(Me) bond is determined by the nature of the heterocumulene organic group. Indeed, if ethyl iso(thio)cyanate is used in the reaction, the insertion is reversible, whereas the reaction with PhNCS (unlike PhNCO) together with carbon dioxide leads to complete insertion into two Re–O(R) bonds to give the insertion product (OMe)10O6Re4[OC(O){N(Ph)C(S)}2-OMe]2. In similar reactions carried out with N,N′-dicyclohexylcarbodiimide, a dependence of the number of bonds participating in the inner-sphere condensation of the inserted moieties on the duration of the experiment was found for the first time. An increase in the time of synthesis from 3 to 5 h results in insertion involving six rather than three bonds, the heteromolecular insertion products being (OMe),O6Re4{OC(O)[(Hex)N=C=N(Hex)]2}3 and (OMe)6O6Re4{OC(O)[(Hex)N=C=N(Hex)]2}6, respectively.