Implantation Site Research Articles

Osseodensification: An Alternative to Conventional Osteotomy in Implant Site Preparation: A Systematic Review.

Osseodensification is an innovative method of preparing the implant osteotomy using drills that promote bone self-compaction. The main objective of this technique is to promote peri-implant bone densification and compaction of autologous bone and to increase the primary stability of the implant due to the viscoelastic characteristics of the alveolar bone using Densah® burs in a counterclockwise direction at a speed of 800 to 1500 rpm. The objective of this review is the analysis of the scientific literature regarding the applicability of the osseodensification technique in oral implantology. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used and registered at PROSPERO. The search strategy included electronic databases from 2016 to 2023 and was performed by two independent reviewers. The results demonstrate the advantage of the osseodensification technique in relation to conventional drilling, allowing an increase in the bone density and primary stability of the implant, bone density, and bone-implant contact. The osseodensification technique can be applied in different clinical situations: sub-antral bone grafts, narrow alveolar bone crests, low-density bone areas, and immediate implant placement in post-extraction sockets.

ZIF-8 nanoparticles combined with fibroin protein co-modified TiO2 nanotube arrays to construct a drug sustained-release platform

Anodized titanium dioxide nanotubes (TNTs) on titanium surface provide a drug delivery platform for local drug therapy at the implantation site. Here, we used TNTs as the drug carrier and modified it with zeolite imidazolium salt skeleton-8 (ZIF-8) combined with silk fibroin (SF) to obtain a new drug loading platform to prolong the drug release time. The morphology, modification effect, drug release in vitro, cell biological activity and osteogenesis of the drug-loaded platform were evaluated. ZIF-8 nanoparticles are mesoporous and filled in nanotubes, and silk fibroin was covered on the surface of nanotubes in the form of thin films. In vitro drug release experiments showed that the silk fibroin membrane combined with biological crosslinking agent genipin (GNP) effectively blocked the diffusion of drugs and prolonged the drug release to 60 days. The study of cell proliferation and osteogenic differentiation showed that the drug-loaded platform was biocompatible and could promote ALP secretion. Therefore, the studies imply that the drug loading platform co-modified by TNTs-based ZIF-8 nanoparticles and silk fibroin can be used as a potential and ideal orthopedic implant.

An unusual location of newborn huge dermoid cyst: a case report and literature review

BackgroundDermoid cysts are benign germ cell tumors with ectodermal and mesodermal components. It is a slow-growing lesion that commonly arises in the midline of the head and neck. The last location represented 7%, and the periorbital region was the most frequently arising area. True lateral neck dermoid cysts are rare. We present an unusual location of a dermoid cyst in a newborn.Case presentationWe report an unusual location of a 10-day newborn giant dermoid cyst with multiple implantation sites, namely the shoulder, scapula, cervical, temporal, and occipital scalp. Successful surgical resection was achieved, and the patient was discharged after the removal of the stitches.ConclusionDermoid cysts are unusual neoplasms with rare diagnoses at birth, but often in childhood. Concomitant implantation locations on the shoulder, neck, temporal, and occipital scalps are rare.

Abstract 18628: Focal Pericoronary Adipose Tissue Evaluated by Electron Density Numbers on Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis

Introduction: Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on electron density number (EDN) as a new parameter, the focal characteristics of PCAT were evaluated. Methods: 17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From contrast data, EDNs of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of the right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which EDNs were determined. Results: For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of EDNS (%EDW) for 81 sites, excluding four sites with a stent implantation, were 93.7, 93.9, 94.0, and 94.3 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated the relationship between age and EDNs in groups 1-4. No correlations were observed in group 1 (R= 0.05), 3 (R= 0.09), and 4 (R= 0,15), however negative correlation was observed in group 2 (R= -0.42) between age and EDNs. No significant differences in EDNs were noted between males and females (P=NS). Conclusions: This is the first study in which focal PCAT was evaluated by EDNs and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of the future occurrence of coronary arterial plaques, which are related to PCAT inflammation.

Abstract 18549: Focal Pericoronary Adipose Tissue Evaluated by Atomic Numbers on Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis

Introduction: Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on atomic number as a new parameter, the focal characteristics of PCAT were evaluated. Methods: 17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From contrast data, atomic numbers of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of the right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which atomic numbers were determined. Results: For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of atomic numbers for 81 sites, excluding four sites with a stent implantation, were 6.4, 6.8, 6.4, and 6.1 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated relationship between age and atomic numbers in groups 1-4. Positive correlations were observed in group 1 (R= 0.25) and 3 (R= 0.39), however negative correlation was observed in group 2 (R= -0.37) and 4 (R= -0.40) between age and atomic numbers. No significant differences in atomic numbers were noted between males and females. Conclusions: This is the first study in which focal PCAT was evaluated by atomic numbers and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of future occurrence of coronary arterial plaques, which are related to PCAT inflammation.

Abstract 18610: Focal Pericoronary Adipose Tissue Evaluated by Electron Density Numbers on Non-Contrast Spectral Computed Tomography Was Associated With Coronary Arterial Plaques: A Site-by-Site Analysis

Introduction: Inflammation in pericoronary adipose tissue (PCAT) around the coronary arterial wall causes coronary arterial sclerosis. Many studies evaluated the relationship between total PCAT volume and coronary arterial sclerosis on a patient-by-patient basis. Hypothesis: Inflammation in PCAT may occur focally in coronary arterial system to which coronary arterial plaques localize. Using novel spectral CT, based on electron density number (EDN) as a new parameter, the focal characteristics of PCAT were evaluated. Methods: 17 patients (10 males, mean age 70 years) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). From non-contrast data, EDNs of PCAT were determined at a 1) right side site and 2) left anterior side site of a proximal portion of right coronary arteries (RCA), 3) anterior side site of the left main coronary arteries, 4) left side site of a proximal portion of the left circumflex artery, and left side site of a distal portion of the RCA (five sites each patient). We also evaluated coronary arterial plaques on enhanced CT images at five corresponding sites for which EDNs were determined. Results: For a total of 85 sites among 17 patients using enhanced CT, 31 sites had no plaques (group 1), 14 sites had only non-calcified plaques (group 2), 20 sites had only calcified plaques (group 3), 16 sites had mixed plaques (group 4), and four sites had stent implantations (group 5). The mean of EDNS (%EDW) for 81 sites, excluding four sites with a stent implantation, were 93.5, 93.3, 93.2, and 93.8 in groups 1-4, respectively (P=NS). For a total of 81 sites, excluding four implantation sites, we evaluated the relationship between age and EDNs in groups 1-4. Positive correlations were observed in group 1 (R= 0.40), and 3 (R= 0.40), however negative correlation was observed in group 2 (R= -0.22) and 3 (R= -0.22) between age and EDNs. No significant differences in EDNs were noted between males and females (P=NS). Conclusions: This is the first study in which focal PCAT was evaluated by EDNs and the relationship to coronary arterial plaques determined by site-by-site analysis. This new CT parameter may evaluate the status of PCAT and be a predictor of the future occurrence of coronary arterial plaques, which are related to PCAT inflammation even on non-contrast CT alone.

Abstract 16739: Tricuspid Regurgitation Following Conduction System Pacing Lead Entanglement in Chordae Tendineae

Case Description: A 62-year-old male with symptomatic sinus bradycardia presented for pacemaker implantation. Conduction system pacing (CSP) was pursued using the Medtronic 3830 lead. The lead was advanced through a C315His sheath and positioned at the basal-mid ventricular septum. Passive pacing demonstrated V1 notching and aVR/aVL discordance. An attempt was made to fixate the lead but despite rapid clockwise turns at the proximal lead tip, no lead penetration was seen in the LAO projection. The lead was removed and the sheath was repositioned. A second attempt was made with similar results. When attempting to remove the lead however, the lead remained adherent to the tissue despite multiple counter-clockwise turns. Increasing traction was applied at the proximal lead tip which resulted in elongation of the fixation screw and eventual disengagement from the tissue. Upon examination of the lead tip, there was fibrinous tissue suggestive of either chordae tendineae or valve remnant. Further attempts at CSP were aborted and the patient underwent traditional RV septal lead placement. Transthoracic echocardiogram (TTE) performed following the procedure demonstrated mild-moderate eccentric tricuspid regurgitation, likely due to chordae injury. Discussion: Left bundle branch pacing (LBBP) is becoming an increasingly popular form of CSP and requires deep penetration of the septum to engage the left bundle branch. To our knowledge, this is only the second case describing tricuspid valve chordae tendineae entanglement as a result of a CSP attempt. Most often, tricuspid regurgitation due to LBBP is attributed to entrapment of the septal TV leaflet from a basal position of the pacing lead. In our case, we suspect tricuspid valve injury occurred as a direct result of entanglement of the screw into the chordae. Potential ways to mitigate this complication are to pursue a more distal implantation site or to confirm adequate passive injury current prior to fixation to ensure the screw tip engages the myocardial tissue. Most of all, it is important to recognize that when a lead is not advancing into the septum, one should abort the position early and try an alternative site to avoid complications.

Surface photosterilization of implantable silicone biomaterials: structural and functional characterization

Hospital-acquired infections (HAIs) remain one of the major challenges faced by the global healthcare system. The increasing rate of pathogenic resistance against antibiotics suggests that alternative treatments are needed to control recurrent infections. Catheter-associated urinary tract infections (CAUTIs) are the third most common type of HAI worldwide, and this is mainly due to indwelling devices being excellent substrates for bacterial adhesion and growth. Subsequent biofilm formation on the implant surface acts as a constant nidus of bacteria and infection, thereby contributing to increased rates of patient morbidity and mortality. Here, we propose a simple and cost-effective method to sterilize silicone-based implant surfaces and prevent initial bacterial colonization, using Polydimethylsiloxane (PDMS) and an embedded ruthenium photosensitizer (PS). Exposure to LED light triggers potent photokilling action, resulting in significant bactericidal activity as evidenced by the number of adherent bacteria being below the level of detection (<10 CFU/mL) after 24 h. Live/dead staining studies using fluorescence microscopy indicated significant reduction in surface-adhered bacterial growth and biofilm formation. This potent antibacterial activity was verified in vivo, with exposure of contaminated PDMS coupons containing PS to LED prior to implantation resulting in over 99.5% reduction in adherent bacteria compared to controls over the 3-day implantation period. Histological analysis of the implantation site of PDMS+PS samples, in the absence of bacteria, revealed no adverse reactions. This was also confirmed using in vitro cytotoxicity studies. Tensile strength, surface roughness, hydrophobicity, and the development of encrustation of surface-treated groups exhibit comparable or improved properties to bare PDMS.

Abstract 14137: Stress-Induced Cardiomyopathy After Uncomplicated Permanent Pacemaker Implantation

Stress-induced cardiomyopathy (SCMP) after permanent pacemaker (PPM) implantation is rare. Here, we report an additional case which was initially misdiagnosed as another disease due to atypical symptoms after PPM implantation. Case presentation: A 79-year-old woman with dizziness and dyspnea for one month visited Cardiology Department. She had a history of hypertension, dyslipidemia, diabetes-mellitus and stage IV chronic kidney disease. We confirmed complete atrioventricular block. Left ventricular ejection fraction (LVEF) was normal. PPM implantation was successfully performed without complications. The next day she felt very well with no symptoms. On the second day, she suddenly developed a fever and complained severe left neck pain. She had cough, sputum and general weakness without chest pain. C-reactive protein level increased and systolic blood pressure was decreased. We started antibiotics considering infection. We also checked implantation site, but there were no signs of infection. On the third day, echocardiography showed decreased LVEF (30%), akinesia of apical and medium segments of LV wall with preserved kinetics of basal segments without pericardial effusion (Figure 1). There was no significant stenosis on coronary angiography and we confirmed SCMP. After few days, her blood pressure and symptoms were improved. We prescribed sacubitril-valsartan, bisoprolol and furosemide. At 10 days after implantation, she was discharged with improved symptoms. Conclusion: Our case emphasizes that even successful implantation of PPM without complications can be a potential risk of SCMP. In the absence of typical cardiac symptoms after PPM implantation, a poor general condition may also be considered as a sign of SCMP. Therefore, it is necessary to monitor the patient for at least three more days after PPM implantation.

Phenotypic Analysis of Periimplantation to Mid-Gestation Lethality in Mice

Periimplantation to mid-gestation lethality is indicated if no living homozygous mutants are recovered at E12.5 and the number of empty implantation sites or degenerating/abnormal embryos fits the expected number of homozygous mutants. To determine the time of death, this overview details the characteristic features of lethality shortly after implantation (E4.5–E5.5) or lethality between gastrulation and allantoic fusion (E6.5–E9.5). Determining the phenotype of the mutants involves making a gross morphological assessment, staging the embryos, and photodocumenting any abnormalities. Further levels of analysis discussed are histological assessment, molecular characterization of gene expression in the mutant embryos, and measurements of cell proliferation and cell death.

Development of a compact NMR system to measure pO2 in a tissue-engineered graft

Cellular macroencapsulation devices, known as tissue engineered grafts (TEGs), enable the transplantation of allogeneic cells without the need for life-long systemic immunosuppression. Islet containing TEGs offer promise as a potential functional cure for type 1 diabetes. Previous research has indicated sustained functionality of implanted islets at high density in a TEG requires external supplementary oxygen delivery and an effective tool to monitor TEG oxygen levels. A proven oxygen-measurement approach employs a 19F oxygen probe molecule (a perfluorocarbon) implanted alongside therapeutic cells to enable oxygen- and temperature- dependent NMR relaxometry. Although the approach has proved effective, the clinical translation of 19F oxygen relaxometry for TEG monitoring will be limited by the current inaccessibility and high cost of MRI. Here, we report the development of an affordable, compact, and tabletop 19F NMR relaxometry system for monitoring TEG oxygenation. The system uses a 0.5 T Halbach magnet with a bore diameter (19 cm) capable of accommodating the human arm, a potential site of future TEG implantation. 19F NMR relaxometry was performed while controlling the temperature and oxygenation levels of a TEG using a custom-built perfusion setup. Despite the magnet’s nonuniform field, a pulse sequence of broadband adiabatic full-passage pulses enabled accurate 19F longitudinal relaxation rate (R1) measurements in times as short as ∼2 min (R1 vs oxygen partial pressure and temperature (R2 > 0.98)). The estimated sensitivity of R1 to oxygen changes at 0.5 T was 1.62-fold larger than the sensitivity previously reported for 16.4 T. We conclude that TEG oxygenation monitoring with a compact, tabletop 19F NMR relaxometry system appears feasible.

Intracerebral Transplantation of Autologous Mesenchymal Stem Cells Improves Functional Recovery in a Rat Model of Chronic Ischemic Stroke.

While treatments exist for the acute phase of stroke, there are limited options for patients with chronic infarcts and long-term disability. Allogenic mesenchymal stem cells (alloMSCs) show promise for the treatment of stroke soon after ischemic injury. There is, however, no information on the use of autologous MSCs (autoMSCs), delivered intracerebrally in rats with a chronic infarct. In this study, rats underwent middle cerebral artery occlusion (MCAO) to induce stroke followed by bone marrow aspiration and MSC expansion in a closed bioreactor. Four weeks later, brain MRI was obtained and autoMSCs (1 × 106, 2.5 × 106 or 5 × 106; n = 6 each) were stereotactically injected into the peri-infarct and compared to controls (MCAO only; MCAO + PBS; n = 6-9). Behavior was assessed using the modified neurological severity score (mNSS). For comparison, an additional cohort of MCAO rats were implanted with 2.5 × 106 alloMSCs generated from a healthy rat. All doses of autoMSCs produced significant improvement (54-70%) in sensorimotor function 60 days later. In contrast, alloMSCs improved only 31.7%, similar to that in PBS controls 30%. Quantum dot-labeled auto/alloMSCs were found exclusively at the implantation site throughout the post-transplantation period with no tumor formation on MRI or Ki67 staining of engrafted MSCs. Small differences in stroke volume and no differences in corpus callosum width were observed after MSC treatment. Stroke-induced glial reactivity in the peri-infarct was long-lasting and unabated by auto/alloMSC transplantation. These studies suggest that intracerebral transplantation of autoMSCs as compared to alloMSCs may be a promising treatment in chronic stroke.

The microbiome of orthopedic implant-associated infections and its correlation with inflammatory markers

Background: Implant site and periprosthetic joint infections (PPJI) are of major concern with tremendous improvement in orthopedic operative procedures. Early diagnosis of infection is the cornerstone for success rate and prevention of implant failure. The need for inflammatory biomarkers followed by culture sensitivity remains inevitable in the diagnosis of infection. Aims and Objectives: The aim is to study the prevalent biofilm-forming pathogens and to correlate with antimicrobial resistance and also to estimate inflammatory markers to predict the presence of PPJI. Materials and Methods: A descriptive cross-sectional study involving 57 patients showing signs of PPJI was evaluated. Clinical samples of these cases were processed, the bacterial pathogens were isolated and bio-film formation was tested. Inflammatory markers C-reactive protein by latex agglutination and interleukin-6 (IL6) by ELISA is determined. Results: A total of 36 bacterial pathogens are isolated, 17% are Gram-positive cocci (GPC) and 46% are Gram-negative bacilli (GNB). Among these, 54% are biofilm producers and pseudomonas species (33%) are predominant. Antibiotic susceptibility studies showed GPC to be highly sensitive to linezolid (100%) and vancomycin (100%). Among GNB, pseudomonal species showed susceptibility of 85%, 57%, and 47% to meropenem, amikacin, and piperacillin–tazobactam, respectively. Acinetobacter is the most resistant isolate. The IL value of 19.5 arrived by the receiver operating curve showed maximum sensitivity and minimal false positivity. Conclusion: Assessing the infection-specific biomarkers like IL6 levels is advantageous in earlier detection of implant site infection and aid in instituting specific antibiotics for the most common implant and PPJI before permanent implant failure and sepsis.

Drill Bit Design and Its Effect on Temperature Distribution and Osteonecrosis During Implant Site Preparation: An Experimental Approach

In this study, the drilling parameters will be evaluated to obtain optimal parameters in minimizing the impact of drilling damage on synthetic bone blocks. The effect of damage observed in the study is osteonecrosis that occurs in the drill hole for implant site preparation, where a smaller value is desired. The drilling parameters are optimized using the Taguchi method with two control factors: the feed rate and spindle speed; each parameter is designed in five levels. This experiment was then carried out on four different designs of drill bits, i.e., Twist (118°and 135°), spherical, and conical drill bits. While experimental planning uses L25 orthogonal arrays, the “smaller is better” approach is used as a standard analysis. The main findings of this research are 118° point angle twist drill bit is the ideal type of drill bit for bone drilling, as it produces less heat than other types of drill bits. The optimal range of feed rate and drilling speed for bone drilling is 40-60 mm/rev and 1000-1400 RPM, respectively. Combining these parameters helps to minimize heat generation during implant site preparation drilling.

Detection of Biofilm Production and Antibiotic Resistance Pattern in Clinical Isolates from Orthopaedic Implants Associated Infections

Introduction: Orthopaedic Implant associated infection is the major problem which leads to implant failure and economic burden to the patient. Implant-associated infections are due to the formation of biofilm at the implantation site leading to multidrug resistant organism. Aim: This study was done to evaluate the causative organisms, their antibiotic sensitivity pattern and their ability to form biofilm over the Implants used in Orthopaedic surgeries. Material and methods: This study was carried out in the department of Microbiology, Adichunchanagiri institute of Medical sciences from September 2019 to August 2022. Swabs from 100 patients who had undergone orthopaedic implant or prosthetic surgery and presented with signs and symptoms of infection were collected and processed as per standard procedures. All the isolates were subjected to detect biofilm production by Congo red agar method, MRSA detection by Cefoxitin disc diffusion test, vancomycin resistant Enterococcus by using Vancomycin (Minimum inhibitory concentration) MIC strips and Extended spectrum β lactamases (ESBL) production by phenotypic confirmatory combined-disc test. Results: Out of the 100 samples processed, culture positivity was observed in 72 specimens. Among them, Staphylococcus aureus 19(26%) was the predominant isolate and 44 (61%) are biofilm producers. 17 (89%) were MRSA (Methicillin resistance Staphylococcus aureus) strains and 15(37%) were ESBL producing strains. Conclusion: The appropriate pre- and post- operative care should be taken to prevent orthopaedic implant associated infections. Staphylococcus spp was the commonest isolate and its ability to produce biofilm indicates the need for an appropriate antibiotic policy and screening for MRSA carriers to reduce the infection. Keywords: Orthopaedic implant, Infection, Biofilm, MRSA, ESBL

Latissimus dorsi flap in breast reconstruction following radical mastectomy and prophylactic subcutaneous mastectomy in the same patient: Case report

One of the most common surgical treatment options for breast cancer is radical mastectomy, which affects the quality of life of patients in remission and their psychological state. One of the solutions to this problem is the use of skin and muscle flaps from other anatomical areas, in particular the back, for plastic reconstruction of the breast after radical mastectomy. The study aimed to present the practical implementation of reconstruction of both breasts in the remote period of radical mastectomy in a patient in remission of breast cancer using a skin and muscle flap of the broadest back muscle in combination with an implant. The patient, who met the criteria for participation in the study, had previously undergone a radical mastectomy of the right breast for direct indications along with radiotherapy. Delayed breast reconstruction within the study was performed 6 years after the planned right-sided mastectomy. The first surgical intervention included marking the back and breast area, excision and harvesting of the flap, preparation of the implantation site and its placement with the implant. Three months after the operation, she underwent a prophylactic mastectomy of the left breast based on molecular genetic testing with immediate reconstruction using the second flap of the broadest back muscle. The surgery was performed using a perimammary approach. Due to the available dissection, various anatomical configurations of the flap, and low-variability vascular anatomy, the latissimus dorsi flap is an adequate choice of material for the reconstruction of radical postmastectomy interventions. The final result of bilateral use of the flap for breast reconstruction after mastectomy is in favour of restoration of the anatomical tissue defect and a satisfactory aesthetic option, without complications in the form of seromas, haematomas, or pain. The result has a positive impact on the quality of life of a patient in remission of breast cancer

Malignant Neoplasms Arising in the Cardiac Pacemaker Cavity: A Systematic Review.

Cancer is the abnormal proliferation of physiologically inadequate cells. Studies have identified the cardiac pacemaker pocket as a site of rare neoplasms. To evaluate the clinical outcomes, treatment, prognosis, and individualized management of tumors originating in the cardiac pacemaker pocket, a systematic review was conducted using case reports and case series available in the PubMed/Medline, Science Direct, Cochrane Central, LILACS, and Scientific Electronic Library Online (Scielo) databases. Pacemaker pocket tumors affected patients with a mean age of 72.9 years, with a higher incidence in males (76.9%, n = 10). The average time for neoplasm development was 4.4 years (54.07 months). The most prevalent model was Medtronic (38.4%, n = 5), with titanium (83.3%) being the most common metal composition. Chemotherapy was the most performed procedure among patients (38.4%), followed by radiation therapy (38.4%) and surgical tumor resection (30.7%). Six analyzed cases (46.1%) resulted in death, and four patients (30.7%) achieved a cure. Patients with pacemakers should be routinely evaluated for the occurrence of malignant tumors at the site of device implantation.

Successful Outcome of a Heterotopic Pregnancy: A Case Report

Heterotopic pregnancy refers to the presence of simultaneous pregnancies at two different implantation sites. We present an unusual case of term heterotopic pregnancy, the ectopic pregnancy being abdominal implantation. The co-existence of spontaneous full term intra-uterine with advanced abdominal ectopic pregnancy and both viable babies without any residual effect or congenital anomalies is one of the rarest forms of heterotopic pregnancy. Other than Ultrasound, increased HCG, or alpha feto protein, sophisticated modern technology like MRI or CT’s Scan absolutely needed for proper diagnosis, placental localization and vascularization to prevent intra-operative catastrophies. J Bangladesh Coll Phys Surg 2023; 41(4): 338-341

Using multilayered neural networks for determining global solar radiation upon tilted surface in Fianarantsoa Madagascar

The knowledge of the local solar radiation characteristics is indispensable in the survey of any system exploiting solar energy in any location. The author is particularly interested by the global solar radiance upon tilted surface per time unit to help operators using solar energy in their work. The target is, among others, helping solar drying operators that need while tuning drying system the knowledge of the global solar radiation that could be received on inclined solar captors in implantation site. The aim of this paper is to use neural network method to search for solar radiation upon a tilted surface. Multilayered neural networks (MNN) trained by gradient back-propagation are used to determine numeric values of monthly means and hourly variations of the global solar radiation upon a titled surface per time unit. The numerical calculations are made with the geographical and meteorological parameters (latitude, longitude and clearness index) of the location of Fianarantsoa, Madagascar.

Material matters: exploring the interplay between natural biomaterials and host immune system

Biomaterials are widely used for various medical purposes, for instance, implants, tissue engineering, medical devices, and drug delivery systems. Natural biomaterials can be obtained from proteins, carbohydrates, and cell-specific sources. However, when these biomaterials are introduced into the body, they trigger an immune response which may lead to rejection and failure of the implanted device or tissue. The immune system recognizes natural biomaterials as foreign substances and triggers the activation of several immune cells, for instance, macrophages, dendritic cells, and T cells. These cells release pro-inflammatory cytokines and chemokines, which recruit other immune cells to the implantation site. The activation of the immune system can lead to an inflammatory response, which can be beneficial or detrimental, depending on the type of natural biomaterial and the extent of the immune response. These biomaterials can also influence the immune response by modulating the behavior of immune cells. For example, biomaterials with specific surface properties, such as charge and hydrophobicity, can affect the activation and differentiation of immune cells. Additionally, biomaterials can be engineered to release immunomodulatory factors, such as anti-inflammatory cytokines, to promote a tolerogenic immune response. In conclusion, the interaction between biomaterials and the body’s immune system is an intricate procedure with potential consequences for the effectiveness of therapeutics and medical devices. A better understanding of this interplay can help to design biomaterials that promote favorable immune responses and minimize adverse reactions.