Search Results (87)

Background/Objectives: This ex vivo study aimed to evaluate the diagnostic performance of ultra-low-dose (ULD) cone-beam computed tomography (CBCT) protocols in detecting vestibular bone defects for immediate implant planning, using intraoral scan (IOS) data as a reference. Methods: Four CBCT protocols (ENDO, A, B, C) were applied to four dried human skulls using a standardized setup and a single CBCT unit (Planmeca ProMax^® 3D Mid, Planmeca Oy, Helsinki, Finland). All scans were taken at 90 kV, with varying parameters: (1) ENDO (40 × 50 mm, 75 µm, 12 mA, 80–120 µSv, 15 s), (2) A (50 × 50 mm, 75 µm, 9 mA, 20–40 µSv, 5 s), (3) B (100 × 60 mm, 150 µm, 7.1 mA, 22–32 µSv, 5 s), and (4) C (100 × 100 mm, 200 µm, 7.1 mA, 44 µSv, 4 s). Vestibular root surfaces of single-rooted teeth (FDI regions 15–25 and 35–45) were digitized via IOS and exported as STL files. CBCT datasets were superimposed using 3D software (Blender 2.79), and surface defects were measured and compared using one-sample t-tests and Bland–Altman analysis. The level of significance was set at p < 0.05. Results: A total of 330 vestibular surfaces from 66 teeth were analyzed. Compared to the IOS reference, protocols ENDO and A showed minimal differences (p > 0.05). In contrast, protocols B and C exhibited statistically significant deviations (p < 0.05). Protocol B demonstrated a mean difference of −0.477 mm² with limits of agreement (LoA) from −2.04 to 1.09 mm² and significant intra-rater variability (p < 0.05). Protocol C revealed a similar mean deviation (−0.455 mm²) but a wider LoA (−2.72 to 1.81 mm²), indicating greater measurement variability. Overall, larger voxel sizes were associated with increased random error, although deviations remained within clinically acceptable limits. Conclusions: Despite statistical significance, deviations for protocols B and C remained within clinically acceptable limits. ULD CBCT protocols are, thus, suitable for evaluating vestibular bone defects with reduced radiation exposure. Full article

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology—ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)—on post-implantation outcomes remains insufficiently characterized. Objectives: This paper aims to evaluate early postoperative outcomes following HM3 LVAD implantation in patients with ICM versus DCM and to identify the preoperative hemodynamic and clinical predictors of early mortality and hemodynamic instability. Methods: We conducted a retrospective single-center cohort study of 30 patients who underwent HM3 LVAD implantation between 2017 and 2024. Patients were stratified by HF etiology (ICM, n = 17; DCM, n = 13), and preoperative clinical, echocardiographic, and right heart catheterization data were analyzed. The primary endpoint was 30-day postoperative survival. Secondary endpoints included postoperative hemodynamic stability and the need for vasopressor support. Results: Non-survivors (n = 13) demonstrated elevated central venous pressure (>16.5 mmHg), mean right ventricular pressure (>31.5 mmHg), and pulmonary vascular resistance (>7.5 Wood units), in addition to higher preoperative creatinine levels and longer cardiopulmonary bypass times. Vasopressor requirement postoperatively was associated with elevated pre-implant systolic pulmonary artery pressure. Conclusions: Preoperative right-sided pressures and renal dysfunction are strong predictors of early mortality following HM3 LVAD implantation. Patients with ICM exhibit greater early left ventricular recovery compared to those with DCM. These findings underscore the importance of comprehensive and personalized preoperative risk stratification—particularly in patients with DCM and pulmonary hypertension—to optimize postoperative outcomes and guide patient selection for durable LVAD support. Full article

Background: This retrospective clinical cohort study aimed to evaluate, over an 18-month follow-up period, implant survival rates, marginal bone loss, peri-implant parameters, and surgical and prosthetic complications in immediately loaded post-extraction implants used for single or partial implant-prosthetic rehabilitations. Methods: Ninety-nine met the inclusion criteria and received a total of 147 implants. Follow-up assessments were conducted at one week and at three, six, and twelve months after prosthesis delivery. Clinical and radiographic parameters were evaluated by three independent practitioners. The variables considered included smoking, systemic conditions, implant site, and prosthetic type. Results: The implant survival rate was 95.92% at 18 months. Failures were more frequent in smokers, patients with systemic diseases, and in the posterior maxilla. Marginal bone loss increased over time, with higher values in posterior regions and in patients with systemic conditions or smoking habits. Peri-implant clinical parameters values negatively increased in smokers. Surgical complications occurred only in smokers and patients with systemic conditions, more frequently in fixed bridge rehabilitations. Prosthetic complications were limited, more common in posterior regions and multi-unit restorations. Conclusions: Immediately loaded post-extraction implants demonstrated high reliability. Careful patient selection and structured follow-up are essential to reduce complications and ensure long-term success. Full article

Background/Objectives: Intracranial macroelectrode implantation is a pivotal clinical tool in the evaluation of drug-resistant epilepsy, allowing further insights into the localization of the epileptogenic zone and the delineation of eloquent cortical regions through cortical stimulation. Additionally, it provides an avenue to study brain functions by analyzing cerebral responses during neuropsychological paradigms. By combining macroelectrodes with microelectrodes, which allow recording the activity of individual neurons or smaller neural clusters, recordings could provide deeper insights into neuronal microcircuits and the brain’s transitions in epilepsy and contribute to a better understanding of neuropsychological functions. In this study, one or two hybrid macro-micro electrodes were implanted in the anterior-inferior insular region in patients with refractory epilepsy. We report our experience and share some preliminary results; we also provide some recommendations regarding the implantation procedure for hybrid electrodes in the insular cortex. Methods: Stereoelectroencephalography was performed in 13 patients, with one or two hybrid macro-microelectrodes positioned in the insular region in each patient. Research neuropsychological paradigms could not be implemented in two patients for clinical reasons. In total, 23 hybrid macro-microelectrodes with eight microcontacts each were implanted, of which 20 were recorded. Spiking activity was detected and assessed using WaveClus3. Results: No spiking neural activity was detected in the microcontacts of the first seven patients. After iterative refinement during this process, successful recordings were obtained from 13 microcontacts in the anterior-inferior insula in the last four patients (13/64, 20.3%). Hybrid electrode implantation was uneventful with no complications. Obstacles included the absence of spiking activity signals, unsuccessful microwire dispersion, and the interference of environmental electrical noise in recordings. Conclusions: Human microelectrode recording presents a complex array of challenges; however, it holds the potential to facilitate a more comprehensive understanding of individual neuronal attributes and their specific stimulus responses. Full article

With the rapid development of electric vehicles, the safety and reliability of lithium-ion batteries (LIBs), as their core energy storage units, have become increasingly prominent. The variation in internal battery pressure is closely related to critical issues such as thermal runaway, mechanical deformation, and lifespan degradation. The non-uniform distribution of internal pressure may trigger localized hot spots or even thermal runaway, posing significant threats to vehicle safety. However, traditional external monitoring methods struggle to accurately reflect internal pressure data, and single-point external pressure measurements fail to capture the true internal state of the battery, particularly within battery modules. This limitation hinders efficient battery management. Addressing the application needs of electric vehicle power batteries, this study integrates thin-film pressure sensors into LIBs through the integrated functional electrode (IFE), enabling distributed in situ monitoring of internal pressure during long-term cycling. Compared to non-implanted benchmark batteries, this design does not compromise electrochemical performance. By analyzing the pressure distribution and evolution data during long-term cycling, the study reveals the dynamic patterns of internal pressure changes in LIBs, offering new solutions for safety warnings and performance optimization of electric vehicle power batteries. This research provides an innovative approach for the internal state monitoring of power batteries, significantly enhancing the safety and reliability of electric vehicle battery systems. Full article

Background: The relationship between dental implants and sinus mucoceles is an area of growing interest in oral and maxillofacial surgery, as therapeutic approaches for these conditions remain controversial. This case report presents a 48-year-old male with no significant medical history who sought dental care due to recurrent abscesses on the distal abutment of a five-unit maxillary bridge. Clinical and radiographic evaluations, including Cone-Beam Computed Tomography (CBCT), revealed a pathologic lesion associated with the second molar, insufficient alveolar bone height in the posterior maxilla, and a radiopaque mass on the sinus floor. Methods: A one-stage surgical approach was planned, involving the second molar extraction, the sinus cyst removal, sinus floor elevation, and simultaneous implant placement. The prosthetic restoration was completed six months postoperatively. Results: Over an 88-month follow-up period, no prosthetic complications were observed, and the patient reported high satisfaction with the restoration’s function and aesthetics. Conclusions: This case highlights a single-stage surgical strategy’s feasibility and long-term success in managing asymptomatic maxillary sinus mucoceles while optimizing implant placement and rehabilitation. Full article

Background: Artificial iris (AI) implantation is an innovative and increasingly utilized surgical procedure for injured eyes with iris trauma. Methods: A 76-year-old female and a 34-year-old male presented at the emergency department with a traumatic corneo-scleral laceration and perforated corneal ulcer, respectively. Emergency surgeries were performed to restore ocular integrity. In both cases, a modified surgical technique involving the implantation of an AI was performed; however, two different models of AI were used. Results: The AIs were sutured with four stitches directly to the scleral-fixated (SF) intra ocular lens (IOL), and the AI-IOL complexes were implanted, as a single unit, and fixated to the sclera using the lens haptics. Before and after the surgery, patients underwent a comprehensive eye examination, including a visual acuity test. The AI-SF IOL complexes remained well positioned, with no intraocular or extraocular complications observed during the follow-up evaluations of both patients. Conclusions: We reported a straightforward and repeatable modified surgical technique for two patients with two models of AI, both sutured to the SF IOL and fixated to the sclera, as a single unit. This approach may serve as an excellent alternative for managing aphakic eyes with extensive iridodialysis or partial aniridia. Full article

Understanding brain function requires advanced neural probes to monitor electrical and chemical signaling across multiple timescales and brain regions. Microelectrode arrays (MEAs) are widely used to record neurophysiological activity across various depths and brain regions, providing single-unit resolution for extended periods. Recent advancements in flexible MEAs, built on micrometer-thick polymer substrates, have improved integration with brain tissue by mimicking the brain’s soft nature, reducing mechanical trauma and inflammation. These flexible, subcellular-scale MEAs can record stable neural signals for months, making them ideal for long-term studies. In addition to electrical recording, MEAs have been functionalized for electrochemical neurotransmitter detection. Electroactive neurotransmitters, such as dopamine, serotonin, and adenosine, can be directly measured via electrochemical methods, particularly on carbon-based surfaces. For non-electroactive neurotransmitters like acetylcholine, glutamate, and γ-aminobutyric acid, alternative strategies, such as enzyme immobilization and aptamer-based recognition, are employed to generate electrochemical signals. This review highlights recent developments in flexible MEA fabrication and functionalization to achieve both electrochemical and electrophysiological recordings, minimizing sensor fowling and brain damage when implanted long-term. It covers multi-time scale neurotransmitter detection, development of conducting polymer and nanomaterial composite coatings to enhance sensitivity, incorporation of enzyme and aptamer-based recognition methods, and the integration of carbon electrodes on flexible MEAs. Finally, it summarizes strategies to acquire electrochemical and electrophysiological measurements from the same device. Full article

Background and Objectives: The utilization of non-metallic pedicle screws and rods has become a favored approach in the management of spinal tumors. An abundance of metal artifacts improves postoperative imaging and allows for precise radiation treatment planning. Under certain conditions, a vertebral body replacement (VBR) is necessary in addition to dorsal fixation. For a long time, VBR hardware was available as titanium implants only. Recently, other non-titanium products were introduced into the market. This study compares radiotherapy planning after VBR with titanium and non-titanium materials. Materials and Methods: This is a retrospective cohort study in a single academic center setting. VBR was performed for thoracic spinal metastatic disease. Radiation plan quality was evaluated according to the criteria of the International Commission on Radiation Units and Measurements, based on postoperative CT imaging. Results: Six patients with dorsal fixation and VBR were included, half of which were treated with titanium VBR and the other half with a minimum metallic implant. In addition, patients received different dorsal fixation hardware. No difference was found in terms of radiation plan quality. With non-titanium materials, visual demarcation during radiation planning was superior. Conclusions: This is the first study in the field to comprehensively compare radiation treatment planning after VBR using different materials. With minimum metallic implants, radiotherapy planning is equal in terms of planning but superior in terms of visual demarcation in comparison to standard titanium VBR, potentially enabling more precise radiotherapy approaches. Full article

Implantable microelectrode arrays (MEAs) enable the recording of electrical activity from cortical neurons for applications that include brain–machine interfaces. However, MEAs show reduced recording capabilities under chronic implantation conditions. This has largely been attributed to the brain’s foreign body response, which is marked by neuroinflammation and gliosis in the immediate vicinity of the MEA implantation site. This has prompted the development of novel MEAs with either coatings or architectures that aim to reduce the tissue response. The present study examines the comparative performance of multi-shank planar, silicon-based devices and low-flexural-rigidity amorphous silicon carbide (a-SiC) MEAs that have a similar architecture but differ with respect to the shank cross-sectional area. Data from a-SiC arrays were previously reported in a prior study from our group. In a manner consistent with the prior work, larger cross-sectional area silicon-based arrays were implanted in the motor cortex of female Sprague-Dawley rats and weekly recordings were made for 16 weeks after implantation. Single unit metrics from the recordings were compared over the implantation period between the device types. Overall, the expression of single units measured from a-SiC devices was significantly higher than for silicon-based MEAs throughout the implantation period. Immunohistochemical analysis demonstrated reduced neuroinflammation and gliosis around the a-SiC MEAs compared to silicon-based devices. Our findings demonstrate that the a-SiC MEAs with a smaller shank cross-sectional area can record single unit activity with more stability and exhibit a reduced inflammatory response compared to the silicon-based device employed in this study. Full article

Background: The volume of cardiac valve and coronary artery revascularization procedures is rising in the United States. This cross-sectional study explores ethnic disparities in mortality in cardiac surgery attributed to mechanical failures of implantable heart valves and coronary artery grafts. Methods: We used the CDC Wide-Ranging Online Data for Epidemiologic Research Multiple Causes of Death database to identify patients whose single cause of death was categorized by complications of cardiovascular prosthetic devices, implants, and grafts (ICD-10 code T82) between 1999 and 2020. The Joinpoint software (version 5.2.0, National Cancer Institute) was used to construct log-linear regression models to estimate the average annual percent changes in age-adjusted mortality (per 100,000). These patterns were compared and stratified by sex, age (0–44, 44–64, and 65 years or older), and US census regions between White, Black, Hispanic, non-Hispanic, American Indian, Alaskan Native, Asian American, and Pacific Islanders. Results: Age-adjusted mortality due to mechanical failures of cardiac implants and grafts declined across ethnicities from 2.21 (95% CI 2.16–2.27) in 1999 to 0.88 (95% CI 0.85–0.91) in 2020. Black populations (1.31 [95% CI 1.20–1.42]), both men (1.56 [95% CI 1.37–1.74]) and women (1.02 [95% CI 0.90–1.15]) experienced higher mortality in 2020 compared to all other ethnicities. This disparity was pronounced in younger groups (age 0–64), wherein age-adjusted mortality among Black populations (0.18 [95% CI 0.13–0.25]) more than doubled that of White populations (0.08 [95% CI 0.06–0.10]). Conclusions: Over the last two decades, age-adjusted mortality due to mechanical complications of cardiovascular implants has declined significantly. However, Black men and women, particularly younger patients, continue to experience higher death rates compared to other ethnicities. Full article

Background: The clinical and laboratory features of patients with non-criteria obstetric antiphospholipid syndrome (NC-OAPS), as well as their pregnancy outcomes and ideal treatment are not clearly determined. The aim of this study is to describe the characteristics and outcomes of pregnancies in NC-OAPS and compare them with an obstetric APS (OAPS) cohort. Methods: This is a retrospective study conducted on a cohort of women referred to a high-risk obstetric unit of a tertiary hospital. Women that were classified as having OAPS or NC-OAPS were included and compared in terms of clinical and laboratory characteristics, management, and subsequent pregnancy outcomes. Results: We identified 107 women with 143 pregnancies, 91 with NC-OAPS and 16 with OAPS. There were no differences in demographic features between both groups. Women with NC-OAPS were more likely to have recurrent implantation failure and were predominantly positive for a single antiphospholipid antibody (aPL) subtype. Both groups were treated similarly (low dose aspirin plus low molecular weight heparin in 87.4% of NC-OAPS and 83.3% of OAPS, p > 0.05). Live birth rate (82.4% and 75.0%, respectively, p > 0.05) and adverse pregnancy outcomes (31.6% vs. 37.5%, p > 0.05) in subsequent pregnancies during follow-up were also similar between groups. Conclusions: This study revealed differences in the previous pregnancy morbidity and aPL profiles in women with NC-OAPS and OAPS, although the therapeutic approach and the outcomes of subsequent pregnancies were similar in both groups. Full article

Background and Objectives: Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which the early pregnancy implants at the site of the uterine scar. Methotrexate (MTX) in lower doses can be used to treat CSPs. However, MTX administration is associated with a spectrum of side effects that include hematological toxicities. This case report presents a CSP treated with an intragestational injection of MTX and subsequently developed pancytopenia. Materials and Methods: A 23-year-old woman at six weeks and six days of pregnancy was referred as a potential case of CSP. After establishing the diagnosis, she was treated with a transvaginal ultrasound-guided intragestational administration of 80 mg MTX (adjusted to 50 mg/m² body surface area) under sedation. Results: On day four after the MTX injection, she developed oral ulcers, fever, and pruritic phlyctenular maculopapular rash. Subsequently, the patient developed febrile neutropenia and was admitted to the Intensive Care Unit. On day six, a subsequent exacerbation of the rash was observed with the formation of blisters and purplish spots with concurrent odynophagia and sialorrhea. Ultimately, the patient developed pancytopenia due to bone marrow suppression. Fifteen days after MTX administration, the patient recovered and was discharged from the hospital hemodynamically stable, afebrile, with dropping β-hcg levels, and in good clinical condition. Conclusions: Although methotrexate administration is the preferred option for the treatment of cesarean scar pregnancies, clinicians should be aware of the fact that its use entails potential risks, even when it is used locally. To our knowledge, this case is the first description of pancytopenia due to bone marrow suppression following a single low dose of intragestational methotrexate injection. Full article

Background: An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pressure in patients. Nevertheless, infections are very frequent complications. Identifying the risk factors for EVD-related infections is a key to improving patient safety and outcomes. Methods: We conducted a retrospective, single-center study of patients who underwent EVD implantation between January 2022 and March 2024. Patients were classified into infected and non-infected groups based on their clinical symptoms, as well as laboratory and microbiological results. Patient characteristics and possible risk factors for infection were compared between the two groups. Results: In total, 123 patients treated with 156 EVDs were included in this study, with a mean age of 55.8 (range: 25–84) years. EVD-associated infections were observed in 37 patients (30%). We found no significant association between infection risk and patient characteristics, including gender, primary diagnosis, craniotomy, or immunosuppression. There was no significant difference in terms of EVD insertion, i.e., whether the insertion took place in the operating room (OR) with antibiotic prophylaxis or outside the OR with no periprocedural antibiotic treatment. However, within the intensive care unit (ICU), EVD infection was much lower (13%) if EVD insertion took place in a single-bed room compared to multiple-bed room insertions (34%). Furthermore, there were significant differences in terms of the duration of first EVD (both single and multiple catheterizations) (p < 0.0001) and the total catheterization time (p = 0.0001). Additionally, there was a significant association with patient days in the ICU and EVD catheterization. Conclusions: Revisiting infection control measures is necessary, with special attention to the replacement of EVDs in single-bed ICU rooms, to introduce antibiotic prophylaxis in the ICU. Minimizing unnecessary EVD manipulation during catheterization is crucial in order to decrease the risk of EVD infection. Full article

The colonization of microbes and the resulting formation of biofilms on dental implants are significant contributors to peri-implantitis and the failure of these implants. The aim of the research was to analyze the impact of density and depth of laser texturing of the Ti-6Al-7Nb alloy surface on the colonization of selected microorganisms and biofilm formation. Standard strains of Gram-negative and Gram-positive bacteria and yeasts from the American Type Culture Collection—ATCC—were used to demonstrate the ability to form single-species biofilms in vitro. The study evaluated three types of titanium samples with different texture density and depth. The colonization and biofilm formation abilities of the tested microorganisms were assessed. The obtained results were subjected to statistical analysis. Among the analyzed strains, L. rhamnosus showed the highest colonization of the tested surfaces. It was found that there is no relationship between the texture parameters and the number of colony-forming units (CFU/mL) for C. albicans, S. mutans, and L. rhamnosus. For the F. nucleatum strain, it was shown that the number of colony-forming bacteria is related to the texture density. Full article