Objective:To compare the effectiveness,safety,acceptability,and confounding factors of the two-rod levonorgestrel implants between the Indoplant and Sinoplant implant brands.Methods:The study was a double-blind,random...Objective:To compare the effectiveness,safety,acceptability,and confounding factors of the two-rod levonorgestrel implants between the Indoplant and Sinoplant implant brands.Methods:The study was a double-blind,randomized controlled trial at three different centers in Indonesia.A total of 531 participants that met inclusion and exclusion criteria were randomized into two groups,with 264 participants in the Sinoplant group and 267 participants in the Indoplant group.At each center,participants were divided into two groups for Sinoplant and Indoplant.The participants were followed up for 36 months.Four parameters were evaluated:implant effectiveness,safety,acceptability,and confounding factors.Results:A total of 531 eligible participants were enrolled in this study.Both Sinoplant and Indoplant showed 100%efficacy in preventing pregnancy,with no significant differences in side effects.24.22%of the Sinoplant group and 22.18%of the Indoplant group reported weight changes.8.60%of the Sinoplant group and 9.73%of the Indoplant group reported menstrual changes,and 1.17%of the both groups experienced intermenstrual bleeding.Implant acceptability was 96.61%,with 3.39%dropout rates.Confounding factors such as age,parity,and contraceptive history did not significantly differ between the two groups.Conclusions:Sinoplant and Indoplant did not differ significantly in contraceptive effectiveness,safety,acceptability,and confounding factors.展开更多
Currently,there is an essential need for bioresorbable bone implants with antibacterial,anti-inflammatory properties as well as osteoinductivity.Considering this,in presented study for the first time hybrid Mg-ZK coat...Currently,there is an essential need for bioresorbable bone implants with antibacterial,anti-inflammatory properties as well as osteoinductivity.Considering this,in presented study for the first time hybrid Mg-ZK coatings with polydopamine(PDA),menaquinone-7(MK-7),zoledronate(ZA)and vancomycin on the hydroxyapatite(HA)containing layer are formed.Porous coatings were obtained by the plasma electrolytic oxidation(PEO)on an Mg alloy,then MK-7 was impregnated into the pores and PDA film with ZA and vancomycin was polymerized on the samples surface.The presence of HA and organic bioactive compounds was confirmed by EDS,Raman spectroscopy,XRD and XPS.Surface free energy values of hybrid coatings are close to optimal for cell adhesion:75.28±1.35 mJ/m^(2).Viability tests of the medium,in which Mg-ZK implants were soaked,revealed cytotoxic activity on human osteosarcoma cells with no such an effect on fibroblasts.Antibacterial tests showed an inhibition zone on S.aureus with no viable colonies on the hybrid coatings.The growth inhibition zones for the samples with the hybrid coating were 21±1 mm.Data of electrochemical impedance spectroscopy shows increase of corrosion resistance of samples with hybrid coating by 7 times comparing the Mg alloy without a coating.These properties make the hybrid Mg-ZK coating an attractive modification for bone implants.展开更多
Additive manufacturing(AM)has revolutionized the production of metal bone implants,enabling unprecedented levels of customization and functionality.Recent advancements in surface-modification technologies have been cr...Additive manufacturing(AM)has revolutionized the production of metal bone implants,enabling unprecedented levels of customization and functionality.Recent advancements in surface-modification technologies have been crucial in enhancing the performance and biocompatibility of implants.Through leveraging the versatility of AM techniques,particularly powder bed fusion,a range of metallic biomaterials,including stainless steel,titanium,and biodegradable alloys,can be utilized to fabricate implants tailored for craniofacial,trunk,and limb bone reconstructions.However,the potential of AM is contingent on addressing intrinsic defects that may hinder implant performance.Techniques such as sandblasting,chemical treatment,electropolishing,heat treatment,and laser technology effectively remove residual powder and improve the surface roughness of these implants.The development of functional coatings,applied via both dry and wet methods,represents a significant advancement in surface modification research.These coatings not only improve mechanical and biological interactions at the implant-bone interface but also facilitate controlled drug release and enhance antimicrobial properties.Addition-ally,micro-and nanoscale surface modifications using chemical and laser techniques can precisely sculpt implant surfaces to promote the desired cellular responses.This detailed exploration of surface engineering offers a wealth of opportunities for creating next-generation implants that are not only biocompatible but also bioactive,laying the foundation for more effective solutions in bone reconstruction.展开更多
In this study,in view of the corrosion resistance and bio functionality limitations of medical magnesium alloys,a PCL/MAO@TiO_(2)NPS composite coating was fabricated to enhance biodegradable magnesium alloy orthopedic...In this study,in view of the corrosion resistance and bio functionality limitations of medical magnesium alloys,a PCL/MAO@TiO_(2)NPS composite coating was fabricated to enhance biodegradable magnesium alloy orthopedic implants.This composite coating effectively inhibited pitting corrosion and decreased the degradation rate of the magnesium alloy substrate.Specifically,the corrosion current density of the overall specimen decreased by five orders of magnitude compared to that of the substrate.In vitro cell experiments demonstrated that the composite coating significantly decelerated the degradation of the magnesium alloy.The degradation products and appropriate magnesium ion concentration promoted cell growth and proliferation.After 72-h co-culturing of specimen extracts with cells,cell viability remained at 100%.Antimicrobial test results showed that due to the synergistic effect of ultraviolet treated TiO_(2)nanoparticles and other components,the specimens exhibited excellent antimicrobial properties.Moreover,in vivo animal implantation tests revealed that the PCL/MAO@TiO_(2)NPS composite coated specimens had remarkable bone enhancing capabilities,which were conducive to the healing and functional restoration of bone tissue.Overall,the numerous advantages suggest that the PCL/MAO@TiO_(2)NPS composite coatings hold great promise for improving magnesium alloy implants in clinical applications.展开更多
The rapid corrosion rate and limited biological functionality still pose challenges for magnesium(Mg)-based implants in the treatment of complicated bone-related diseases in clinic.Herein,a multifunctional biodegradab...The rapid corrosion rate and limited biological functionality still pose challenges for magnesium(Mg)-based implants in the treatment of complicated bone-related diseases in clinic.Herein,a multifunctional biodegradable curcumin(herbal medicine)-ferrum(Cur-Fe)nanoflower was self-assembled on plasma electrolytic oxidation(PEO)-treated Mg alloy via a facile immersion process to realize differential biological function for anti-bacteria/tumor and bone regeneration.The results indicated that Cur-Fe nanoflower coating can promote protein adsorption,cell adhesion and proliferation,exhibiting excellent biocompatibility.The Cur-Fe nanoflower coating exhibits unique degradation characteristics,as curcumin gradually decomposes into ferulic acid,aromatic aldehyde and other antibacterial substances,and the coating spontaneously converts into FeOOH nanosheets,ensuring the corrosion resistance of Mg-based implants.Moreover,Cur-Fe coating exhibits remarkable narrow gap semiconductor characteristics,which can generate reactive oxygen species(ROS)and demonstrated excellent antibacterial effect under simulated sunlight(SSL)irradiation.Meanwhile,under NIR irradiation,Cur-Fe coating showed excellent chemotherapy/photodynamic/photothermal synergetic antitumor properties in vitro and in vivo due to the introduction of curcumin,and photocatalysis and photothermal conversion properties of coating.Furthermore,Cur-Fe nanoflower coating demonstrated great osteogenesis activity in vitro and in vivo due to unique micro/nano structure,surface chemical bond,and the release of Mg and Fe ions.展开更多
The bioinert nature of polyether ether ketone(PEEK)material limits the widespread clinical application of PEEK implants.Although the porous structure is considered to improve osseointegration of PEEK implants,it is ha...The bioinert nature of polyether ether ketone(PEEK)material limits the widespread clinical application of PEEK implants.Although the porous structure is considered to improve osseointegration of PEEK implants,it is hardly used due to its mechanical properties.This study investigated the combined influence of the porous structure and in vivo mechanical stimulation on implantation safety and bone growth based on finite element analysis of the biomechanical behavior of the implantation system.The combined control of pore size and screw preloads allows the porous PEEK implant to achieve good osseointegration while maintaining a relatively high safety level.A pore size of 600μm and a preload of 0.05 N·m are the optimal combination for the long-term stability of the implant,with which the safety factor of the implant is>2,and the predicted percentage of effective bone growth area of the bone-implant interface reaches 97%.For further clinical application,PEEK implants were fabricated with fused filament fabrication(FFF)three-dimensional(3D)printing,and clinical outcomes demonstrated better bone repair efficacy and long-term stability of porous PEEK implants compared to solid PEEK implants.Moreover,good osteointegration performance of 3D-printed porous PEEK implants was observed,with an average bone volume fraction>40%three months after implantation.In conclusion,3D-printed porous PEEK implants have great potential for clinical application,with validated implantation safety and good osseointegration.展开更多
Triply periodic minimal surface(TPMS)-based bone implants are an innovative approach in orthopedic implantology,offering customized solutions for bone defect repair and regeneration.This review comprehensively examine...Triply periodic minimal surface(TPMS)-based bone implants are an innovative approach in orthopedic implantology,offering customized solutions for bone defect repair and regeneration.This review comprehensively examines the current research landscape of TPMS-based bone implants,addressing key challenges and proposing future directions.It explores design strategies aimed at optimizing mechanical strength and enhancing biological integration,with a particular emphasis on TPMS structures.These design strategies include graded,hierarchical,and hybrid designs,each contributing to the overall functionality and performance of the implants.This review also highlights state-of-the-art fabrication technologies,particularly advancements in additive manufacturing(AM)techniques for creating metal-based,polymer-based,and ceramic-based bone implants.The ability to precisely control the architecture of TPMS structures using AM techniques is crucial for tailoring the mechanical and biological properties of such implants.Furthermore,this review critically evaluates the biological performance of TPMS implants,focusing on their potential to promote bone ingrowth and regeneration.Key factors,such as mechanical properties,permeability,and biocompatibility,are examined to determine the effectiveness of these implants in clinical applications.By synthesizing existing knowledge and proposing innovative research directions,this review underscores the transformative potential of TPMS-based bone implants in orthopedic surgery.The objective is to improve clinical outcomes and enhance patient care through advanced implant designs and manufacturing techniques.展开更多
Boron nitride(BN),as a nano-reinforcement,offers notable benefits for zinc(Zn)-based implants due to its distinct asymmetric hexagonal structure and high fracture strength.However,the limited interface adhesion betwee...Boron nitride(BN),as a nano-reinforcement,offers notable benefits for zinc(Zn)-based implants due to its distinct asymmetric hexagonal structure and high fracture strength.However,the limited interface adhesion between BN and Zn limits its potential for strengthening and toughening.In this study,copper(Cu)was in situ grown on acidified BN through chemical synthesis and subsequently incorporated into laser additive manufacturing of Zn to enhance interface bonding.During this process,the Cu on BN experienced a displacement reaction with Zn due to thermal reduction induced by the high-energy laser,leading to the replacement of Cu by Zn and the formation of a robust covalent bond between BN and the Zn matrix,thereby improving load transfer.Additionally,the reduced Cu further interacted with Zn to produce the CuZn5 phase,which was evenly dispersed in the Zn matrix under Marangoni vortices,resulting in both dispersion and Orowan strengthening.Consequently,the ultimate tensile strength of the composites achieved(251±7)MPa.The fracture toughness also showed a notable increase from 12.10 to 24.03 MPa·m^(1/2),as the unique structure of BN effectively redistributed stress at the crack tip and absorbed considerable fracture energy.Furthermore,the Cu@BN/Zn implants demonstrated excellent antibacterial properties.展开更多
Biodegradable magnesium(Mg)-based metals can undergo spontaneous corrosion and full degradation in the human body,releasing magnesium ions,hydroxides,and hydrogen.Mg and its alloys have shown preliminary success as an...Biodegradable magnesium(Mg)-based metals can undergo spontaneous corrosion and full degradation in the human body,releasing magnesium ions,hydroxides,and hydrogen.Mg and its alloys have shown preliminary success as an implantable biomaterial.Current research on biodegradable Mg-based metals addresses clinical challenges,including material design and preparation,property enhancement,and exploring relevant biological functions.This review provides a comprehensive overview of the biomedical applications of Mg-based implants across eight fields:cardiovascular,orthopedics,stomatology,general surgery,neurosurgery,fat metabolism,and other potential areas,building upon previously published work.The challenges and prospects of biodegradable Mg-based implants in these application fields are discussed.展开更多
Thoracic reconstructions are essential surgical techniques used to replace severely damaged tissues and restore protection to internal organs.In recent years,advancements in additive manufacturing have enabled the pro...Thoracic reconstructions are essential surgical techniques used to replace severely damaged tissues and restore protection to internal organs.In recent years,advancements in additive manufacturing have enabled the production of thoracic implants with complex geometries,offering more versatile performance.In this study,we investigated a design based on a spring-like geometry manufactured by laser powder bed fusion(LPBF),as proposed in earlier research.The biomechanical behavior of this design was analyzed using various isolated semi-ring-rib models at different levels of the rib cage.This approach enabled a comprehensive examination,leading to the proposal of several implant configurations that were incorporated into a 3D rib cage model with chest wall defects,to simulate different chest wall reconstruction scenarios.The results revealed that the implant design was too rigid for the second rib level,which therefore was excluded from the proposed implant configurations.In chest wall reconstruction simulations,the maximum stresses observed in all prostheses did not exceed 38%of the implant material's yield stress in the most unfavorable case.Additionally,all the implants showed flexibility compatible with the physiological movements of the human thorax.展开更多
Osteoporotic fractures often exhibit delayed healing and repair difficulties in which the bone immune microenvironment may play a critical role,but direct evidence remains elusive.Recently,magnesium(Mg)-based alloys h...Osteoporotic fractures often exhibit delayed healing and repair difficulties in which the bone immune microenvironment may play a critical role,but direct evidence remains elusive.Recently,magnesium(Mg)-based alloys have emerged as promising biodegradable materials capable of promoting fracture healing.Herein,we performed internal fixation of high-purity Mg implants for osteoporotic fractures and used single-cell studies to investigate and elucidate the cellular heterogeneity and dynamic changes that occurred during osteoporotic fracture repair.We observed an early increase in immature neutrophil numbers,together with anti-inflammatory changes in lymphocytes and macrophages.A cluster of macrophages exhibited pro-angiogenic capabilities activated via the TRPM7/S100A4 pathway.These findings provide new theoretical insights into the biological effects of Mg-based materials on the healing of osteoporotic fractures.展开更多
The degradation characteristics of high-purity(HP)magnesium(Mg)orthopedic implants under static and cyclic compressive loads(SCL and CCL)remain inadequately understood.This study developed an in vivo loading device ca...The degradation characteristics of high-purity(HP)magnesium(Mg)orthopedic implants under static and cyclic compressive loads(SCL and CCL)remain inadequately understood.This study developed an in vivo loading device capable of applying single SCL and CCL while shielding against unpredictable host movements.In vitro degradation experiments of HP Mg implants were conducted to verify the experimental protocol,and in vivo experiments in rabbit tibiae to observe the degradation characteristics of the implants.Micro-computed tomography and scanning electron microscope were used for three-dimensional reconstruction and surface morphology analysis,respectively.Compared to in vitro specimens,in vivo specimens exhibited significantly higher corrosion rates and more extensive cracking.Cracks in the in vivo specimens gradually penetrated deeper from the loading surface,eventually leading to a rapid structural deterioration;whereas in vitro specimens exhibited more surface-localized cracking and a relatively uniform corrosion pattern.Compared to SCL,CCL accelerated both corrosion and cracking to some extent.These findings provide new insights into the in vivo degradation behavior of Mg-based implants under compressive loading conditions.展开更多
The effect of structure,elastic modulus and thickness of lower modulus layer in porous titanium implants on the stress distribution at the implant-bone interface was investigated.Three-dimensional finite element model...The effect of structure,elastic modulus and thickness of lower modulus layer in porous titanium implants on the stress distribution at the implant-bone interface was investigated.Three-dimensional finite element models of different titanium implants were constructed.The structures of the implants included the whole lower modulus style （No.1）,bio-mimetic style （No.2）,the whole lower modulus style in cancellous bone （No.3） and the whole dense style No.4.The stress distributions at bone-implant interface under static loading were analyzed using Ansys Workbench 10.0 software.The results indicated that the distribution of interface stress is strongly depended on the structure of the implants.The maximum stresses in cancellous bone and root region of implant No.2 are lower than those in the other three implants.A decrease in the modulus of the low modulus layer facilitates the interface stress transferring.Increasing the thickness of the low modulus layer can reduce the stress and induce a more uniform stress distribution at the interface.Among the four implants,biomimetic style implant No.2 is superior in transferring implant-bone interface stress to surrounding bones.展开更多
The development of substitutable meniscus implants that can effectively protect articular cartilage remains a great challenge.Herein,a polyurethane with chemical crosslinking and sulfobetaine extenders containing hydr...The development of substitutable meniscus implants that can effectively protect articular cartilage remains a great challenge.Herein,a polyurethane with chemical crosslinking and sulfobetaine extenders containing hydrophobic chains(PU-CL-hSB)is developed,which could improve comprehensive properties and long-term stability simultaneously.By regulating the mole ratio of functional groups,PU-CL-hSB with appropriate mechanical properties,excellent tribological properties,and good fatigue resistance is used to prepare substitutable meniscus implant by hot-pressing.Due to the synergistic effect of functional groups,PU-CL-hSB meniscus implant presents comparable or even superior properties to native meniscus.It withstands a maximum force of 26.08 N versus 25.14 N for native meniscus,an energy dissipation from 45.93 to 39.17 N mm compared to 28.83 to 19.11 N mm for native meniscus over 300 cycles,and a friction coefficient from 0.08 to 0.19 compared to 0.11 to 0.26 for native meniscus.This PU-CL-hSB meniscus implant is further implanted into live rabbit knee joints for 8 and 25 weeks by a new approach,and in vivo data indicate that PU-CL-hSB meniscus implant not only protects articular cartilage from severe damage without eliciting inflammatory responses,but also can maintain normal physiological activities in the native state.Our findings present a substitutable meniscus implant that could be applied in vivo and propose evaluation methodologies for meniscus implants.展开更多
Objective:To explore the application effect of digital intraoral scanning impression technique in oral implant restoration for periodontitis patients and analyze its impact on patients’Visual Analogue Scale(VAS)score...Objective:To explore the application effect of digital intraoral scanning impression technique in oral implant restoration for periodontitis patients and analyze its impact on patients’Visual Analogue Scale(VAS)scores.Methods:A total of 80 periodontitis patients who received implant restoration in our hospital from May 2023 to May 2025 were selected as research subjects.They were randomly divided into an observation group and a control group using a random number table method,with 40 cases in each group.The observation group used the digital intraoral scanning impression technique to obtain impressions,while the control group used the traditional silicone rubber impression technique.The impression-taking time,the number of prostheses try-ins,implant survival rate,periodontal health indicators(probing depth,gingival index,bleeding index),and VAS scores(pain during treatment and comfort after restoration)were compared between the two groups.Results:The observation group was superior to the control group in terms of impression-taking time,the number of prostheses try-ins,and implant survival rate(p<0.05).Six months after restoration,the improvement in periodontal health indicators in the observation group was significantly better than that in the control group(p<0.05).In addition,the pain VAS score of the observation group during treatment was lower than that of the control group,and the comfort VAS score after restoration was higher than that of the control group(p<0.05).Conclusion:Digital intraoral scanning impression technology can effectively enhance the efficiency and success rate of implant restoration in periodontitis patients,improve periodontal health,alleviate patients’discomfort during treatment,and increase post-restoration comfort,demonstrating high clinical application value.展开更多
Objective:To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the elec...Objective:To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the electrode-neural interface.Methods:A prospective observational study involving 56 pediatric patients underwent cochlear implantation with Cochlear Nucleus devices.Intraoperative polarized impedance and electrically evoked compound action potential(ECAP)threshold were recorded across all 1232 electrodes using AutoNRT software.Eight electrodes with open-or short-circuit were excluded,leaving 1,224 for analysis.Impedance values were categorized by cochlear region(basal,middle,apical),and electrodes with elevated impedance(10-20 kΩ)were analyzed for regional distribution and clinical relevance.Data were analyzed for spatial patterns and correlation with the ECAP threshold profiles.Results:A consistent basal-to-apical increase in impedance was observed(7.7±1.9,9.2±1.4,10.8±1.5 kΩ;p<0.001).Impedance and ECAP threshold were weakly correlated(ρ=-0.20,p<0.001;β=-1.26,p<0.001),with a positive association in the apical region(ρ=0.12,p=0.048).Electrodes with higher impedance(1020 kΩ)were less likely to show elevated or absent TNRT(OR=0.175,p=0.02).The impedance gradient persisted across age groups and was significantly correlated with ECAP threshold patterns.Conclusion:Intraoperative impedance monitoring reveals a strong and physiologically consistent gradient,with higher values in apical electrodes.This gradient reflects anatomical and tissue interface variations,which may offer a valuable physiological indicator for intraoperative electrode positioning and neural interface integrity.展开更多
Background:Inflatable Penile Prosthesis(IPP)is the treatment for erectile dysfunction(ED)refractory to pharmacological therapies.Long-term data on factors associated with prosthesis survival remain unclear.This study ...Background:Inflatable Penile Prosthesis(IPP)is the treatment for erectile dysfunction(ED)refractory to pharmacological therapies.Long-term data on factors associated with prosthesis survival remain unclear.This study aimed to analyze the long-term survival of penile prostheses and identify risk factors associated with survival without reintervention.Methods:This is a retrospective,single-center study of patients who underwent IPP implantation between January 2014 and December 2022.Preoperative data related to the patient and the etiology of ED,as well as perioperative data,were collected.The primary outcome was survival without reintervention,defined as prosthesis revision or explantation due to mechanical dysfunction or infection.We conducted survival analyses without reintervention and searched for risk factors using a multivariate Cox model.Results:In total,33 out of 137 patients underwent reintervention(24.1%),including 24(17.5%)prosthesis revisions and 9(6.6%)had explantations.Median follow-up was 39 months with an interquartile range(IQR)of 9.00 to 62.00.Median survival without reintervention was 7 years.In univariate analysis,downsizing(p=0.046)was associated with reintervention.Smoking(p=0.003)and age(p=0.034)were associated with prosthesis explantation.The number of implantations(p=0.009)was associated with prosthesis revision.Multivariate analysis by the Cox model did not identify any independent predictive factors for reintervention.Conclusion:Smoking may play a role in infection post-IPP implantation.Primary implantations seem to be associated with better survival.Adjusting cylinder size,known as downsizing,is likely to be a proxy for the complexity of the procedure and thus linked to earlier reintervention.展开更多
AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabe...AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.展开更多
AIM:To evaluate the differences and consistency of vault measurements obtained by Scheimpflug tomography(Pentacam),anterior segment optical coherence tomography(AS-OCT,CASIA II),and ultrasound biomicroscopy(UBM)follow...AIM:To evaluate the differences and consistency of vault measurements obtained by Scheimpflug tomography(Pentacam),anterior segment optical coherence tomography(AS-OCT,CASIA II),and ultrasound biomicroscopy(UBM)following implantable collamer lens(ICL)V4c implantation.METHODS:Vault measurements were acquired using three modalities:Pentacam,CASIA II AS-OCT,and UBM.Repeated-measures analysis of variance was used to compare the vault values obtained by the three devices.The correlation and consistency of measurements among the three instruments were assessed using the Pearson correlation coefficient,intraclass correlation coefficient(ICC),and Bland-Altman plots.RESULTS:This retrospective study enrolled 210 myopic eyes of 210 patients(158 women and 52 men)who underwent ICL implantation:108 eyes had a myopic ICL V4c implanted,and 102 eyes had a toric ICL V4c implanted.The mean vault values measured by Pentacam,CASIA II,and UBM were 452.64±204.20μm,538.57±203.54μm,and 560.95±227.54μm,respectively,with statistically significant differences among the three groups(P<0.05).Pearson correlation analysis showed strong positive correlations between vault values measured by different instruments(all P<0.001).ICC results indicated good consistency among the three measurement modalities(all P<0.001).Stratified analysis revealed that when the vault value was≤250μm,the correlation and consistency of measurements across the three instruments were lower than those in the medium and high vault subgroups.CONCLUSION:Vault values measured by Pentacam are lower than those obtained by CASIA II and UBM,with UBM yielding the highest mean vault values.Measurements from the three instruments are not interchangeable but can serve as mutual references due to their significant correlation and good overall consistency.Pentacam and CASIA II demonstrate the highest consistency in vault measurement.Notably,when the vault value is≤250μm,the consistency between Pentacam and the other two instruments decreases significantly.展开更多
Objectives:To investigate the imaging characteristics,surgical approaches,and outcomes of cochlear implantation(CI)in patients with special inner ear malformations(IEMs)that show transitional forms between cochlear hy...Objectives:To investigate the imaging characteristics,surgical approaches,and outcomes of cochlear implantation(CI)in patients with special inner ear malformations(IEMs)that show transitional forms between cochlear hypoplasia(CH)and common cavity(CC).Methods:Twelve children(eight males,four females),aged 10 to 43 months,with special IEMs were enrolled,and their inner ear structures were analyzed using detailed segmentation.Two surgical approaches were employed:the transmastoid slot labyrinthotomy approach(TSLA)for cases requiring customized electrodes,and the round window or cochleostomy approach for the remaining cases.Outcomes were evaluated using Categories of Auditory Performance(CAP),Speech Intelligibility Rating(SIR),and Meaningful Auditory Integration Scale(MAIS/IT-MAIS)at 12 months post-implantation.Results:Two main types of malformed cochleae were identified:common cavity-like and primitive CH types.All patients exhibited cochlear nerve deficiency and significant bilateral differences in their inner ear structures.Four patients underwent TSLA with customized electrodes,while the remaining patients received lateral wall electrodes via the round window or cochleostomy approach.Most patients showed improvement in auditory and speech capabilities following implantation.Conclusion:Inner ear malformations with transitional forms between CH and CC present unique challenges,requiring detailed preoperative evaluation and customized surgical plans.Even in severe cases,carefully planned surgery can lead to meaningful auditory rehabilitation.展开更多
基金supported by PT.Catur Dakwah Crane Pharmacy,an Indonesian pharmaceutical company.The funding was granted through a mutual agreement between the research team and the company,under the coordination of the National Population and Family Planning Board(BKKBN Indonesia).The funder provided financial support only and had no role in the study design,data collection,analysis,interpretation of data,or the decision to submit the manuscript for publication.
文摘Objective:To compare the effectiveness,safety,acceptability,and confounding factors of the two-rod levonorgestrel implants between the Indoplant and Sinoplant implant brands.Methods:The study was a double-blind,randomized controlled trial at three different centers in Indonesia.A total of 531 participants that met inclusion and exclusion criteria were randomized into two groups,with 264 participants in the Sinoplant group and 267 participants in the Indoplant group.At each center,participants were divided into two groups for Sinoplant and Indoplant.The participants were followed up for 36 months.Four parameters were evaluated:implant effectiveness,safety,acceptability,and confounding factors.Results:A total of 531 eligible participants were enrolled in this study.Both Sinoplant and Indoplant showed 100%efficacy in preventing pregnancy,with no significant differences in side effects.24.22%of the Sinoplant group and 22.18%of the Indoplant group reported weight changes.8.60%of the Sinoplant group and 9.73%of the Indoplant group reported menstrual changes,and 1.17%of the both groups experienced intermenstrual bleeding.Implant acceptability was 96.61%,with 3.39%dropout rates.Confounding factors such as age,parity,and contraceptive history did not significantly differ between the two groups.Conclusions:Sinoplant and Indoplant did not differ significantly in contraceptive effectiveness,safety,acceptability,and confounding factors.
基金The formation of coatingsas well as SEM,EDS,FIB,Raman spectroscopy,XRD,XPS,EIS,IR spectra,release studies and antibacterial studies were supported by Russian Science Foundation Grant No 22-73-10149,https://rscf.ru/project/22-73-10149/The wettability studies,all viability tests,alizarin red assay,evaluation of inflammatory activity and adhesion tests were supported by Russian Science Foundation Grant No 23-13-00329,https://rscf.ru/project/23-13-00329/。
文摘Currently,there is an essential need for bioresorbable bone implants with antibacterial,anti-inflammatory properties as well as osteoinductivity.Considering this,in presented study for the first time hybrid Mg-ZK coatings with polydopamine(PDA),menaquinone-7(MK-7),zoledronate(ZA)and vancomycin on the hydroxyapatite(HA)containing layer are formed.Porous coatings were obtained by the plasma electrolytic oxidation(PEO)on an Mg alloy,then MK-7 was impregnated into the pores and PDA film with ZA and vancomycin was polymerized on the samples surface.The presence of HA and organic bioactive compounds was confirmed by EDS,Raman spectroscopy,XRD and XPS.Surface free energy values of hybrid coatings are close to optimal for cell adhesion:75.28±1.35 mJ/m^(2).Viability tests of the medium,in which Mg-ZK implants were soaked,revealed cytotoxic activity on human osteosarcoma cells with no such an effect on fibroblasts.Antibacterial tests showed an inhibition zone on S.aureus with no viable colonies on the hybrid coatings.The growth inhibition zones for the samples with the hybrid coating were 21±1 mm.Data of electrochemical impedance spectroscopy shows increase of corrosion resistance of samples with hybrid coating by 7 times comparing the Mg alloy without a coating.These properties make the hybrid Mg-ZK coating an attractive modification for bone implants.
基金supported by National Natural Science Foundation of China(Grant No.52275343)Natural Science Foundation of Zhejiang Province(Grant No.LY23E050003)Ningbo Youth Science and Technology Innovation Leading Talent Project(Grant No.2023QL021).
文摘Additive manufacturing(AM)has revolutionized the production of metal bone implants,enabling unprecedented levels of customization and functionality.Recent advancements in surface-modification technologies have been crucial in enhancing the performance and biocompatibility of implants.Through leveraging the versatility of AM techniques,particularly powder bed fusion,a range of metallic biomaterials,including stainless steel,titanium,and biodegradable alloys,can be utilized to fabricate implants tailored for craniofacial,trunk,and limb bone reconstructions.However,the potential of AM is contingent on addressing intrinsic defects that may hinder implant performance.Techniques such as sandblasting,chemical treatment,electropolishing,heat treatment,and laser technology effectively remove residual powder and improve the surface roughness of these implants.The development of functional coatings,applied via both dry and wet methods,represents a significant advancement in surface modification research.These coatings not only improve mechanical and biological interactions at the implant-bone interface but also facilitate controlled drug release and enhance antimicrobial properties.Addition-ally,micro-and nanoscale surface modifications using chemical and laser techniques can precisely sculpt implant surfaces to promote the desired cellular responses.This detailed exploration of surface engineering offers a wealth of opportunities for creating next-generation implants that are not only biocompatible but also bioactive,laying the foundation for more effective solutions in bone reconstruction.
基金supported by National Natural Science Foundation of China(Grant no 52371070 and 52271249)Key Research and Development Program of Shaanxi(2023-YBGY-488)+1 种基金State Key Laboratory of Solidification Processing in NPU(Grant no SKLSP202415)Xi’an Talent Plan(XAYC240016).
文摘In this study,in view of the corrosion resistance and bio functionality limitations of medical magnesium alloys,a PCL/MAO@TiO_(2)NPS composite coating was fabricated to enhance biodegradable magnesium alloy orthopedic implants.This composite coating effectively inhibited pitting corrosion and decreased the degradation rate of the magnesium alloy substrate.Specifically,the corrosion current density of the overall specimen decreased by five orders of magnitude compared to that of the substrate.In vitro cell experiments demonstrated that the composite coating significantly decelerated the degradation of the magnesium alloy.The degradation products and appropriate magnesium ion concentration promoted cell growth and proliferation.After 72-h co-culturing of specimen extracts with cells,cell viability remained at 100%.Antimicrobial test results showed that due to the synergistic effect of ultraviolet treated TiO_(2)nanoparticles and other components,the specimens exhibited excellent antimicrobial properties.Moreover,in vivo animal implantation tests revealed that the PCL/MAO@TiO_(2)NPS composite coated specimens had remarkable bone enhancing capabilities,which were conducive to the healing and functional restoration of bone tissue.Overall,the numerous advantages suggest that the PCL/MAO@TiO_(2)NPS composite coatings hold great promise for improving magnesium alloy implants in clinical applications.
基金supported by the National Key R&D Program of China(2021YFC2400500)Shanghai Committee of Science and Technology,China(20S31901200)+2 种基金the Fundamental Research Funds for the Central Universities(2022ZYGXZR042)Postdoctoral Science Foundation of China(2022M723288)GDPH Supporting Fund for Talent Program(KY0120220137).
文摘The rapid corrosion rate and limited biological functionality still pose challenges for magnesium(Mg)-based implants in the treatment of complicated bone-related diseases in clinic.Herein,a multifunctional biodegradable curcumin(herbal medicine)-ferrum(Cur-Fe)nanoflower was self-assembled on plasma electrolytic oxidation(PEO)-treated Mg alloy via a facile immersion process to realize differential biological function for anti-bacteria/tumor and bone regeneration.The results indicated that Cur-Fe nanoflower coating can promote protein adsorption,cell adhesion and proliferation,exhibiting excellent biocompatibility.The Cur-Fe nanoflower coating exhibits unique degradation characteristics,as curcumin gradually decomposes into ferulic acid,aromatic aldehyde and other antibacterial substances,and the coating spontaneously converts into FeOOH nanosheets,ensuring the corrosion resistance of Mg-based implants.Moreover,Cur-Fe coating exhibits remarkable narrow gap semiconductor characteristics,which can generate reactive oxygen species(ROS)and demonstrated excellent antibacterial effect under simulated sunlight(SSL)irradiation.Meanwhile,under NIR irradiation,Cur-Fe coating showed excellent chemotherapy/photodynamic/photothermal synergetic antitumor properties in vitro and in vivo due to the introduction of curcumin,and photocatalysis and photothermal conversion properties of coating.Furthermore,Cur-Fe nanoflower coating demonstrated great osteogenesis activity in vitro and in vivo due to unique micro/nano structure,surface chemical bond,and the release of Mg and Fe ions.
基金supported by the National Key R&D Program of China(No.2023YFB4603500)the Program for Innovation Team of Shaanxi Province(No.2023-CX-TD-17)+1 种基金the Fundamental Research Funds for the Central Universitiesthe Shaanxi Province Qinchuangyuan“Scientist+Engineer”Team Construction Project(No.2022KXJ-106).
文摘The bioinert nature of polyether ether ketone(PEEK)material limits the widespread clinical application of PEEK implants.Although the porous structure is considered to improve osseointegration of PEEK implants,it is hardly used due to its mechanical properties.This study investigated the combined influence of the porous structure and in vivo mechanical stimulation on implantation safety and bone growth based on finite element analysis of the biomechanical behavior of the implantation system.The combined control of pore size and screw preloads allows the porous PEEK implant to achieve good osseointegration while maintaining a relatively high safety level.A pore size of 600μm and a preload of 0.05 N·m are the optimal combination for the long-term stability of the implant,with which the safety factor of the implant is>2,and the predicted percentage of effective bone growth area of the bone-implant interface reaches 97%.For further clinical application,PEEK implants were fabricated with fused filament fabrication(FFF)three-dimensional(3D)printing,and clinical outcomes demonstrated better bone repair efficacy and long-term stability of porous PEEK implants compared to solid PEEK implants.Moreover,good osteointegration performance of 3D-printed porous PEEK implants was observed,with an average bone volume fraction>40%three months after implantation.In conclusion,3D-printed porous PEEK implants have great potential for clinical application,with validated implantation safety and good osseointegration.
基金funded by the National Natural Science Foundation of China(No.52275343)the Natural Science Foundation of Zhejiang Province(No.LY23E050003)+1 种基金Ningbo Youth Science and Technology Innovation Leading Talent Project(No.2023QL021)Smart Medicine and Engineering Interdisciplinary Innovation Project of Ningbo University(No.ZHYG001).
文摘Triply periodic minimal surface(TPMS)-based bone implants are an innovative approach in orthopedic implantology,offering customized solutions for bone defect repair and regeneration.This review comprehensively examines the current research landscape of TPMS-based bone implants,addressing key challenges and proposing future directions.It explores design strategies aimed at optimizing mechanical strength and enhancing biological integration,with a particular emphasis on TPMS structures.These design strategies include graded,hierarchical,and hybrid designs,each contributing to the overall functionality and performance of the implants.This review also highlights state-of-the-art fabrication technologies,particularly advancements in additive manufacturing(AM)techniques for creating metal-based,polymer-based,and ceramic-based bone implants.The ability to precisely control the architecture of TPMS structures using AM techniques is crucial for tailoring the mechanical and biological properties of such implants.Furthermore,this review critically evaluates the biological performance of TPMS implants,focusing on their potential to promote bone ingrowth and regeneration.Key factors,such as mechanical properties,permeability,and biocompatibility,are examined to determine the effectiveness of these implants in clinical applications.By synthesizing existing knowledge and proposing innovative research directions,this review underscores the transformative potential of TPMS-based bone implants in orthopedic surgery.The objective is to improve clinical outcomes and enhance patient care through advanced implant designs and manufacturing techniques.
基金supported by the National Key Research and Development Program of China(No.2023YFB4605800)the Natural Science Foundation of China(Nos.51935014,52165043 and 82072084)+4 种基金Jiangxi Provincial Cultivation Program for Academic and Technical Leaders of Major Subjects(No.20225BCJ23008)Jiangxi Provincial Natural Science Foundation of China(Nos.20224ACB204013 and 20224ACB214008)the Technology Innovation Platform Project of Shenzhen Institute of Information Technology 2020(No.PT2020E002)the Shccig-Qinling Program(No.2022360702014891)Jiangxi University of Science and Technology Graduate Innovation Special Fund Project(No.XY2023-S677).
文摘Boron nitride(BN),as a nano-reinforcement,offers notable benefits for zinc(Zn)-based implants due to its distinct asymmetric hexagonal structure and high fracture strength.However,the limited interface adhesion between BN and Zn limits its potential for strengthening and toughening.In this study,copper(Cu)was in situ grown on acidified BN through chemical synthesis and subsequently incorporated into laser additive manufacturing of Zn to enhance interface bonding.During this process,the Cu on BN experienced a displacement reaction with Zn due to thermal reduction induced by the high-energy laser,leading to the replacement of Cu by Zn and the formation of a robust covalent bond between BN and the Zn matrix,thereby improving load transfer.Additionally,the reduced Cu further interacted with Zn to produce the CuZn5 phase,which was evenly dispersed in the Zn matrix under Marangoni vortices,resulting in both dispersion and Orowan strengthening.Consequently,the ultimate tensile strength of the composites achieved(251±7)MPa.The fracture toughness also showed a notable increase from 12.10 to 24.03 MPa·m^(1/2),as the unique structure of BN effectively redistributed stress at the crack tip and absorbed considerable fracture energy.Furthermore,the Cu@BN/Zn implants demonstrated excellent antibacterial properties.
基金supported by grants from the Fundamental Research Funds for the Central Universities(No.2232024D-34 and No 2232023A-10)the National Natural Science Foundation of China(No.52201300)+4 种基金the National Key R&D Program of China(No.2023YFC2416800)the Shanghai Pujiang Program(No.23PJ1400500 and No 23PJ1400600)the State Key Laboratory for Modification of Chemical Fibers and Polymer Materials,Major/key program(No.23M1060280)the Science and Technology Project of Jiangsu Province(No.BE2022758)the Medicine-Engineering Interdisciplinary Project of Shanghai Xuhui District Dental Center(No.SHXYFYG202305).
文摘Biodegradable magnesium(Mg)-based metals can undergo spontaneous corrosion and full degradation in the human body,releasing magnesium ions,hydroxides,and hydrogen.Mg and its alloys have shown preliminary success as an implantable biomaterial.Current research on biodegradable Mg-based metals addresses clinical challenges,including material design and preparation,property enhancement,and exploring relevant biological functions.This review provides a comprehensive overview of the biomedical applications of Mg-based implants across eight fields:cardiovascular,orthopedics,stomatology,general surgery,neurosurgery,fat metabolism,and other potential areas,building upon previously published work.The challenges and prospects of biodegradable Mg-based implants in these application fields are discussed.
文摘Thoracic reconstructions are essential surgical techniques used to replace severely damaged tissues and restore protection to internal organs.In recent years,advancements in additive manufacturing have enabled the production of thoracic implants with complex geometries,offering more versatile performance.In this study,we investigated a design based on a spring-like geometry manufactured by laser powder bed fusion(LPBF),as proposed in earlier research.The biomechanical behavior of this design was analyzed using various isolated semi-ring-rib models at different levels of the rib cage.This approach enabled a comprehensive examination,leading to the proposal of several implant configurations that were incorporated into a 3D rib cage model with chest wall defects,to simulate different chest wall reconstruction scenarios.The results revealed that the implant design was too rigid for the second rib level,which therefore was excluded from the proposed implant configurations.In chest wall reconstruction simulations,the maximum stresses observed in all prostheses did not exceed 38%of the implant material's yield stress in the most unfavorable case.Additionally,all the implants showed flexibility compatible with the physiological movements of the human thorax.
基金financially supported by the National Natural Science Foundation of China(Nos.81871742 and 82102538)Shanghai Sailing Program(No.21YF1405800)+2 种基金Shanghai Pudong Science and Technology Development Funding(No.PKJ2020-Y44)the Featured Clinical Discipline Project of Shanghai Pudong New District(No.Pwyts2021-03)the support of the National Engineering Research Center of Light Alloy Net Forming,Shanghai Jiao Tong University
文摘Osteoporotic fractures often exhibit delayed healing and repair difficulties in which the bone immune microenvironment may play a critical role,but direct evidence remains elusive.Recently,magnesium(Mg)-based alloys have emerged as promising biodegradable materials capable of promoting fracture healing.Herein,we performed internal fixation of high-purity Mg implants for osteoporotic fractures and used single-cell studies to investigate and elucidate the cellular heterogeneity and dynamic changes that occurred during osteoporotic fracture repair.We observed an early increase in immature neutrophil numbers,together with anti-inflammatory changes in lymphocytes and macrophages.A cluster of macrophages exhibited pro-angiogenic capabilities activated via the TRPM7/S100A4 pathway.These findings provide new theoretical insights into the biological effects of Mg-based materials on the healing of osteoporotic fractures.
基金supported by National Natural Science Foundation of China[51975317].
文摘The degradation characteristics of high-purity(HP)magnesium(Mg)orthopedic implants under static and cyclic compressive loads(SCL and CCL)remain inadequately understood.This study developed an in vivo loading device capable of applying single SCL and CCL while shielding against unpredictable host movements.In vitro degradation experiments of HP Mg implants were conducted to verify the experimental protocol,and in vivo experiments in rabbit tibiae to observe the degradation characteristics of the implants.Micro-computed tomography and scanning electron microscope were used for three-dimensional reconstruction and surface morphology analysis,respectively.Compared to in vitro specimens,in vivo specimens exhibited significantly higher corrosion rates and more extensive cracking.Cracks in the in vivo specimens gradually penetrated deeper from the loading surface,eventually leading to a rapid structural deterioration;whereas in vitro specimens exhibited more surface-localized cracking and a relatively uniform corrosion pattern.Compared to SCL,CCL accelerated both corrosion and cracking to some extent.These findings provide new insights into the in vivo degradation behavior of Mg-based implants under compressive loading conditions.
基金Project(30770576) supported by the National Natural Science Foundation of ChinaProject(2007AA03Z114) supported by Hi-tech Research and Development Program of ChinaProject supported by State Key Laboratory of Powder Metallurgy,China
文摘The effect of structure,elastic modulus and thickness of lower modulus layer in porous titanium implants on the stress distribution at the implant-bone interface was investigated.Three-dimensional finite element models of different titanium implants were constructed.The structures of the implants included the whole lower modulus style （No.1）,bio-mimetic style （No.2）,the whole lower modulus style in cancellous bone （No.3） and the whole dense style No.4.The stress distributions at bone-implant interface under static loading were analyzed using Ansys Workbench 10.0 software.The results indicated that the distribution of interface stress is strongly depended on the structure of the implants.The maximum stresses in cancellous bone and root region of implant No.2 are lower than those in the other three implants.A decrease in the modulus of the low modulus layer facilitates the interface stress transferring.Increasing the thickness of the low modulus layer can reduce the stress and induce a more uniform stress distribution at the interface.Among the four implants,biomimetic style implant No.2 is superior in transferring implant-bone interface stress to surrounding bones.
基金supported by the Special Project for High-tech Industrialization of Science and Technology Cooperation between Jilin Province and Chinese Academy of Sciences(2023SYHZ0042)。
文摘The development of substitutable meniscus implants that can effectively protect articular cartilage remains a great challenge.Herein,a polyurethane with chemical crosslinking and sulfobetaine extenders containing hydrophobic chains(PU-CL-hSB)is developed,which could improve comprehensive properties and long-term stability simultaneously.By regulating the mole ratio of functional groups,PU-CL-hSB with appropriate mechanical properties,excellent tribological properties,and good fatigue resistance is used to prepare substitutable meniscus implant by hot-pressing.Due to the synergistic effect of functional groups,PU-CL-hSB meniscus implant presents comparable or even superior properties to native meniscus.It withstands a maximum force of 26.08 N versus 25.14 N for native meniscus,an energy dissipation from 45.93 to 39.17 N mm compared to 28.83 to 19.11 N mm for native meniscus over 300 cycles,and a friction coefficient from 0.08 to 0.19 compared to 0.11 to 0.26 for native meniscus.This PU-CL-hSB meniscus implant is further implanted into live rabbit knee joints for 8 and 25 weeks by a new approach,and in vivo data indicate that PU-CL-hSB meniscus implant not only protects articular cartilage from severe damage without eliciting inflammatory responses,but also can maintain normal physiological activities in the native state.Our findings present a substitutable meniscus implant that could be applied in vivo and propose evaluation methodologies for meniscus implants.
文摘Objective:To explore the application effect of digital intraoral scanning impression technique in oral implant restoration for periodontitis patients and analyze its impact on patients’Visual Analogue Scale(VAS)scores.Methods:A total of 80 periodontitis patients who received implant restoration in our hospital from May 2023 to May 2025 were selected as research subjects.They were randomly divided into an observation group and a control group using a random number table method,with 40 cases in each group.The observation group used the digital intraoral scanning impression technique to obtain impressions,while the control group used the traditional silicone rubber impression technique.The impression-taking time,the number of prostheses try-ins,implant survival rate,periodontal health indicators(probing depth,gingival index,bleeding index),and VAS scores(pain during treatment and comfort after restoration)were compared between the two groups.Results:The observation group was superior to the control group in terms of impression-taking time,the number of prostheses try-ins,and implant survival rate(p<0.05).Six months after restoration,the improvement in periodontal health indicators in the observation group was significantly better than that in the control group(p<0.05).In addition,the pain VAS score of the observation group during treatment was lower than that of the control group,and the comfort VAS score after restoration was higher than that of the control group(p<0.05).Conclusion:Digital intraoral scanning impression technology can effectively enhance the efficiency and success rate of implant restoration in periodontitis patients,improve periodontal health,alleviate patients’discomfort during treatment,and increase post-restoration comfort,demonstrating high clinical application value.
文摘Objective:To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the electrode-neural interface.Methods:A prospective observational study involving 56 pediatric patients underwent cochlear implantation with Cochlear Nucleus devices.Intraoperative polarized impedance and electrically evoked compound action potential(ECAP)threshold were recorded across all 1232 electrodes using AutoNRT software.Eight electrodes with open-or short-circuit were excluded,leaving 1,224 for analysis.Impedance values were categorized by cochlear region(basal,middle,apical),and electrodes with elevated impedance(10-20 kΩ)were analyzed for regional distribution and clinical relevance.Data were analyzed for spatial patterns and correlation with the ECAP threshold profiles.Results:A consistent basal-to-apical increase in impedance was observed(7.7±1.9,9.2±1.4,10.8±1.5 kΩ;p<0.001).Impedance and ECAP threshold were weakly correlated(ρ=-0.20,p<0.001;β=-1.26,p<0.001),with a positive association in the apical region(ρ=0.12,p=0.048).Electrodes with higher impedance(1020 kΩ)were less likely to show elevated or absent TNRT(OR=0.175,p=0.02).The impedance gradient persisted across age groups and was significantly correlated with ECAP threshold patterns.Conclusion:Intraoperative impedance monitoring reveals a strong and physiologically consistent gradient,with higher values in apical electrodes.This gradient reflects anatomical and tissue interface variations,which may offer a valuable physiological indicator for intraoperative electrode positioning and neural interface integrity.
文摘Background:Inflatable Penile Prosthesis(IPP)is the treatment for erectile dysfunction(ED)refractory to pharmacological therapies.Long-term data on factors associated with prosthesis survival remain unclear.This study aimed to analyze the long-term survival of penile prostheses and identify risk factors associated with survival without reintervention.Methods:This is a retrospective,single-center study of patients who underwent IPP implantation between January 2014 and December 2022.Preoperative data related to the patient and the etiology of ED,as well as perioperative data,were collected.The primary outcome was survival without reintervention,defined as prosthesis revision or explantation due to mechanical dysfunction or infection.We conducted survival analyses without reintervention and searched for risk factors using a multivariate Cox model.Results:In total,33 out of 137 patients underwent reintervention(24.1%),including 24(17.5%)prosthesis revisions and 9(6.6%)had explantations.Median follow-up was 39 months with an interquartile range(IQR)of 9.00 to 62.00.Median survival without reintervention was 7 years.In univariate analysis,downsizing(p=0.046)was associated with reintervention.Smoking(p=0.003)and age(p=0.034)were associated with prosthesis explantation.The number of implantations(p=0.009)was associated with prosthesis revision.Multivariate analysis by the Cox model did not identify any independent predictive factors for reintervention.Conclusion:Smoking may play a role in infection post-IPP implantation.Primary implantations seem to be associated with better survival.Adjusting cylinder size,known as downsizing,is likely to be a proxy for the complexity of the procedure and thus linked to earlier reintervention.
文摘AIM:To compare the anatomical and functional outcomes of combined phacoemulsification with intravitreal dexamethasone implant(DEX-I)versus anti-vascular endothelial growth factor(VEGF)injections in patients with diabetic macular edema(DME)and visually significant cataract.METHODS:This nonrandomized,retrospective analysis included 54 eyes undergoing phacoemulsification with DEX-I(DEX-I group)and 47 eyes receiving anti-VEGF injections(anti-VEGF group).Best-corrected visual acuity(BCVA)and central macular thickness(CMT)were measured preoperatively and postoperatively at 1 and 3mo.RESULTS:The two groups had comparable baseline characteristics,with similar age(DEX-I:66.83±7.27y;anti-VEGF:66.81±6.79y)and gender distribution(51.9%vs 59.6%males).Both groups showed significant BCVA improvement at 1 and 3mo,with no significant intergroup differences.CMT reduction was significantly greater in the DEX-I group at 3mo(25.03%vs 14.07%;P=0.049),particularly in recalcitrant eyes(25.09%vs 11.10%;P=0.007).Postoperative intraocular pressure(IOP)>21 mm Hg was observed in 14.8%of DEX-I eyes and 4.25%of anti-VEGF eyes(P=0.08),normalizing by 3mo.DEX-I required no reinjection,while 29.79%of anti-VEGF eyes needed a fourth dose at 3mo.Complications were minimal,with one posterior capsular injury in the DEX-I group.CONCLUSION:Combined phacoemulsification with intravitreal DEX-I offers superior CMT reduction and comparable visual acuity improvement to anti-VEGF injections in DME,with fewer required treatments.It is an effective strategy for managing cataract with DME,offering benefits,especially for recalcitrant cases.Both therapies have favourable safety profiles,but further long-term studies are needed for clinical guidance.
基金Supported by the National Natural Science Foundation of China(No.82171095)the Project of Shanghai Science and Technology(No.23XD1400500)the Research Fund of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital(No.24QNPY049).
文摘AIM:To evaluate the differences and consistency of vault measurements obtained by Scheimpflug tomography(Pentacam),anterior segment optical coherence tomography(AS-OCT,CASIA II),and ultrasound biomicroscopy(UBM)following implantable collamer lens(ICL)V4c implantation.METHODS:Vault measurements were acquired using three modalities:Pentacam,CASIA II AS-OCT,and UBM.Repeated-measures analysis of variance was used to compare the vault values obtained by the three devices.The correlation and consistency of measurements among the three instruments were assessed using the Pearson correlation coefficient,intraclass correlation coefficient(ICC),and Bland-Altman plots.RESULTS:This retrospective study enrolled 210 myopic eyes of 210 patients(158 women and 52 men)who underwent ICL implantation:108 eyes had a myopic ICL V4c implanted,and 102 eyes had a toric ICL V4c implanted.The mean vault values measured by Pentacam,CASIA II,and UBM were 452.64±204.20μm,538.57±203.54μm,and 560.95±227.54μm,respectively,with statistically significant differences among the three groups(P<0.05).Pearson correlation analysis showed strong positive correlations between vault values measured by different instruments(all P<0.001).ICC results indicated good consistency among the three measurement modalities(all P<0.001).Stratified analysis revealed that when the vault value was≤250μm,the correlation and consistency of measurements across the three instruments were lower than those in the medium and high vault subgroups.CONCLUSION:Vault values measured by Pentacam are lower than those obtained by CASIA II and UBM,with UBM yielding the highest mean vault values.Measurements from the three instruments are not interchangeable but can serve as mutual references due to their significant correlation and good overall consistency.Pentacam and CASIA II demonstrate the highest consistency in vault measurement.Notably,when the vault value is≤250μm,the consistency between Pentacam and the other two instruments decreases significantly.
基金supported by the National Key Research and Development Program of China(grant no.2022YFC2402705)National Municipal Natural Science Foundation(grant no.82471161)Beijing Municipal Natural Science Foundation(grant no.7244308).
文摘Objectives:To investigate the imaging characteristics,surgical approaches,and outcomes of cochlear implantation(CI)in patients with special inner ear malformations(IEMs)that show transitional forms between cochlear hypoplasia(CH)and common cavity(CC).Methods:Twelve children(eight males,four females),aged 10 to 43 months,with special IEMs were enrolled,and their inner ear structures were analyzed using detailed segmentation.Two surgical approaches were employed:the transmastoid slot labyrinthotomy approach(TSLA)for cases requiring customized electrodes,and the round window or cochleostomy approach for the remaining cases.Outcomes were evaluated using Categories of Auditory Performance(CAP),Speech Intelligibility Rating(SIR),and Meaningful Auditory Integration Scale(MAIS/IT-MAIS)at 12 months post-implantation.Results:Two main types of malformed cochleae were identified:common cavity-like and primitive CH types.All patients exhibited cochlear nerve deficiency and significant bilateral differences in their inner ear structures.Four patients underwent TSLA with customized electrodes,while the remaining patients received lateral wall electrodes via the round window or cochleostomy approach.Most patients showed improvement in auditory and speech capabilities following implantation.Conclusion:Inner ear malformations with transitional forms between CH and CC present unique challenges,requiring detailed preoperative evaluation and customized surgical plans.Even in severe cases,carefully planned surgery can lead to meaningful auditory rehabilitation.
