Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 7 Articles
Theprogramming of CIs is essential for good performance.However, no Good Clinical Practice guidelines exist. This paper reports\r\non the results of an inventory of the current practice worldwide. A questionnairewas distributed to 47 CI centers.They follow 47600\r\nrecipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified\r\nthrough individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging\r\n5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session,\r\nfollowed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming\r\nand testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are\r\noften determined on a few electrodes and then extrapolated.They aremainly based on subjective loudness perception by the CI user\r\nand, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP\r\nprofile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation\r\nexists between centers on all aspects of the fitting practice....
This paper presents a new method to separate cells on microscopic surfaces joined together in cell clusters into individual cells.\r\nImportant features of this method are that the remaining object geometry is preserved and few contour points are required\r\nfor finding joints between neighboring cells. There are alternative methods such as morphological operations or the watershed\r\ntransformation based on the inverse distance transformation but they have certain disadvantages compared to themethod presented\r\nin this paper. The discussed method contains knowledge-based components in form of a decision function and exchangeable rules\r\nto avoid unwanted separations....
Objectives.This study aimed to evaluate the effect of immediate and delayed loading of orthodontic micro-implants on bone-implant\r\ncontact. Materials and Methods. Sixty four micro-implants were implanted in dog�s jaw bone. The micro-implants were divided into\r\nloaded and unloaded (control) groups. The control group had two subgroups: four and eight weeks being implanted.The loaded\r\ngroup had two subgroups of immediate loading and delayed (after four weeks healing) loading. Loaded samples were subjected to\r\n200g load for four weeks. After sacrificing the animals micro-implants and surrounding tissues were observed histologically. Boneimplant\r\ncontact ratios (BIC) were calculated and different groups� results were compared by three-way ANOVA. Results. Mean\r\nsurvival rate was 96.7% in general. Survival rates were 96.7%, 94.4% and 100% for control, immediate and delayed loaded groups,\r\nrespectively. BIC values were not significantly different in loaded and control groups, immediate and delayed loading groups, and\r\npressure and tension sides. Mandibular micro-implants had significantly higher BIC than maxillary ones in immediate loading,\r\n4-weeks control, and 8-weeks control groups (P = 0.021, P = 0.009, P = 0.003, resp.). Conclusion Immediate or delayed loading of\r\nmicro-implants in dog did not cause significant difference in Bone-implant contact which could be concluded that healing time\r\nhad not significant effect on micro-implant stability....
Aims.This retrospective analysis was aimed at evaluating the effectiveness of treatment of persistent diabetic macular edema with\r\nintravitreal injections of 0.7mg dexamethasone implant Ozurdex. The study comprised three male patients (6 eyes). Results. The\r\naverage thickness of the retina at baseline was 632 �µm, the medial BCVA was 0.8 logMAR, and corrected intraocular pressure\r\nwas 13.7mmHg. The maximum decrease in mean retinal thickness was observed at four weeks following the treatment and was\r\n365 �µm (-267 �µm) and visual acuity improved by an average of two lines and was 0.6 logMAR.The largest increase in mean retinal\r\nthickness to average of 528 �µm (? �µm) occurred at 16 weeks and the average BCVA was 0.614 lines BCVA logMAR. In one eye,\r\nthere was a steroid cataract development after the third dose of dexamethasone implant of 0.7mg. Conclusions. The intravitreal\r\ndexamethasone implant treatment of patients with persistent diabetic macular edema in whom laser photocoagulation proved to\r\nbe ineffective and as a result they required a monthly injection of anti-VEGF factors (Ranibizumab, Bevacizumab) may be a good\r\nalternative to extending the interval of injections. However, reinjections involve a high risk of developing poststeroid cataracts,\r\nwhich is not without significance in middle-aged patients....
Objective.The paper aims to demonstrate the feasibility of defining a substantial set of psychoacoustic outcome measures with preset\r\ntargets and to adopt a systematicmethodology for reaching these targets in a large group of subjects, bymore than one clinical centre.\r\nDesign. Retrospective data analysis. Setting. Multicentre with 14 participating centres. Patients. 255 adults and children using the\r\nAdvanced Bionics HiRes90k cochlear implant. Intervention. Target driven fitting with the fitting to outcomes expert (FOX) system.\r\nMain Outcome Measures. For each patient, 66 measurable psychoacoustical outcomes were recorded several times after cochlear\r\nimplantation: free field audiometry (6 measures) and speech audiometry (4), spectral discrimination (20), and loudness growth\r\n(36), defined from the A�§E test battery. These outcomes were reduced to 22 summary variables. The initial results were compared\r\nwith the latest results. Results.The state of the fitting process could bewellmonitored bymeans of themeasured variables.The use of\r\nthe FOX computer assisted CI-programming significantly improved the proportion of the 22 variables on target.When recipients\r\nused the automated MAPs provided at switch-on, more than half (57%) of the 22 targets were already achieved before any further\r\noptimisation took place.Once the FOX system was applied there was a significant 24%(P < 0.001) increase in the number of targets\r\nachieved. Conclusions.This study demonstrates that it is feasible to set targets and to report on the effectiveness of a fitting strategy\r\nin terms of these targets. FOX provides an effective tool for achieving a systematic approach to programming, allowing for better\r\noptimisation of recipientsâ�� MAPs. The setting of well-defined outcome targets allowed a range of different centres to successfully\r\napply a systematic methodology to monitoring the quality of the programming provided....
Study Design. Combinations of metal implants (stainless steel (SS), titanium (Ti), and cobalt chrome (CC)) were placed in porcine\r\nspines. After 12 months, tissue response and implant corrosionwere compared between mixed and singlemetal junctions.Objective.\r\nModel development and an attempt to determine any detriment of combining differentmetals in posterior spinal instrumentation.\r\nMethods. Yucatan mini-pigs underwent instrumentation over five unfused lumbar levels. A SS rod and a Ti rod were secured with\r\nTi and SS pedicle screws, SS and Ti crosslinks, SS and CC sublaminar wires, and Ti sublaminar cable.The resulting 4 SS/SS, 3 Ti/Ti,\r\nand 11 connections between dissimilar metals per animal were studied after 12 months using radiographs, gross observation, and\r\nhistology (foreign body reaction (FBR), metal particle count, and inflammation analyzed). Results. Two animals had constructs\r\nin place for 12 months with no complications. Histology of tissue over SS/SS connections demonstrated 11.1 �± 7.6 FBR cells, 2.1 �±\r\n1.7 metal particles, and moderate to extensive inflammation. Ti/Ti tissue showed 6.3 �± 3.8 FBR cells, 5.2 �± 6.7 particles, and no to\r\nextensive inflammation (83% extensive). Tissue over mixed components had 14.1 �± 12.6 FBR cells and 13.4 �± 27.8 particles. Samples\r\nsurrounding wires/cables versus other combinations demonstrated FBR (12.4 �± 13.5 versus 12.0 �± 9.6 cells, P = 0.96), particles (19.8\r\n�± 32.6 versus 4.3 �± 12.7, P = 0.24), and inflammation (50% versus 75% extensive, P = 0.12). Conclusions. A nonfusion model was\r\ndeveloped to study corrosion and analyze biological responses. Although no statistical differences were found in overlying tissue\r\nresponse to single versus mixed metal combinations, galvanic corrosion between differing metals is not ruled out. This pilot study\r\nsupports further investigation to answer concerns when mixing metals in spinal constructs....
Bacterial infections of bones remain a serious complication of endoprosthetic surgery. These infections are difficult to treat,\r\nbecause many bacterial species form biofilms on implants, which are relatively resistant towards antibiotics. Bacterial biofilms\r\nelicit a progressive local inflammatory response, resulting in tissue damage and bone degradation. In the majority of patients,\r\nreplacement of the prosthesis is required. To address the question of how the local inflammatory response is linked to bone\r\ndegradation, tissue samples were taken during surgery and gene expression of the macrophage inflammatory proteins MIP1a\r\n(CCL3) and MIP2?? (CXCL2) was assessed by quantitative RT-PCR. MIPs were expressed predominantly at osteolytic sites, in close\r\ncorrelation with CD14 which was used as marker for monocytes/macrophages. Colocalisation of MIPs with monocytic cells could\r\nbe confirmed by histology. In vitro experiments revealed that, aside from monocytic cells, also osteoblasts were capable of MIP\r\nproduction when stimulated with bacteria; moreover, CCL3 induced the differentiation of monocytes to osteoclasts. In conclusion,\r\nthe multifunctional chemokines CCL3 and CXCL2 are produced locally in response to bacterial infection of bones. In addition to\r\ntheir well described chemokine activity, these cytokines can induce generation of bone resorbing osteoclasts, thus providing a link\r\nbetween bacterial infection and osteolysis....
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