Designing and making an open source, 3D-printed, punctal plug with drug delivery system

With the advancement in the study of keratoconjunctivitis sicca and the scope of its treatment, punctal plugs are being widely used for the therapeutic management of dry eye disease. With the emergence of 3D printing in medicine, 3D printing of punctal plugs that have an inbuilt drug delivery system and also that can be personalized from patient to patient according to their punctum size can be a great therapeutic option. Another benefit of the device is that its printing takes a short period of time and is cost-effective. This study aimed at making an open source design and 3D printing an efficient model of a punctal plug with an inbuilt drug delivery system that can be eventually used for the treatment of various ocular diseases that require frequent drug instillation or blockage of the nasolacrimal pathway. The 3D design for the punctal plug was made using the open source application, FreeCAD, and slicing was done using the application ChituBox. After that, the plugs were printed using the LCD printer Crealty LD-002R. The material used was resin that was compatible with the Crealty LD-002R. Punctal plugs with satisfactory results were printed using the LCD printer. The punctal plugs showed suitable structure and were also easily reproduced in the 3D printer without any complications or setbacks.

Does leukocyte-platelet-rich fibrin (L-PRF) cause long term acceleration in the rate of canine retraction? A split-mouth, two-arm parallel group, randomized control trial

ABSTRACT Objective: The present study was conducted to investigate the effects of leukocyte-platelet-rich fibrin (L-PRF) on the rate of maxillary canine retraction for a period of 5 months. Methods: A split-mouth study was conducted on 16 subjects (9 males and 7 females; age range 17-25 years; mean age, 21.85±2.45 years) who required therapeutic extraction of bilateral maxillary first premolars. After the initial leveling and alignment, L-PRF plugs were placed in a randomly selected extraction socket (Experimental Group), and the other side served as a control (Control Group). Canine retraction was carried out by the activation of nickel-titanium (NiTi) closed-coil springs delivering 150 g of force. The rates of canine movement, canine rotation, tipping, root resorption, and molar movement were assessed at monthly intervals for five months (T0-T5). Pain, swelling and discomfort accompanying the procedure were assessed using a Likert scale. Results: The study revealed a significant increase in the rate of canine movement on the experimental side in the first two months, and significant molar anchorage loss was observed only in the first month for control side. There were no statistically significant differences between the groups regarding canine rotation, tipping, probing depth, root resorption, and pain perception. Conclusions: The use of L-PRF plugs in extraction sockets considerably enhanced the rate of canine movement only in the first two months, and long-term efficacy was not observed in this study.

RESUMO Objetivo: O presente estudo foi realizado para investigar os efeitos da fibrina rica em leucócitos e plaquetas (L-PRF) na taxa de retração do canino superior, durante um período de cinco meses. Métodos: Um estudo de boca dividida foi realizado em 16 indivíduos (9 homens e 7 mulheres; faixa etária de 17 a 25 anos; idade média de 21,85 ± 2,45 anos) que precisavam de extração terapêutica dos primeiros pré-molares superiores de ambos os lados. Após o nivelamento e o alinhamento iniciais, os plugs de L-PRF foram colocados em um alvéolo pós-extração, selecionado aleatoriamente (Grupo Experimental), e o outro lado serviu como controle (Grupo Controle). A retração do canino foi realizada pela ativação de molas fechadas de níquel-titânio (NiTi) com 150 g de força. As taxas de movimentação do canino, rotação, inclinação e reabsorção radicular do canino e movimentação do molar foram avaliadas em intervalos mensais durante cinco meses (T0-T5). A dor, o inchaço e o desconforto após o procedimento foram avaliados por meio de uma escala de Likert. Resultados: O estudo revelou um aumento significativo na taxa de movimentação do canino no lado experimental nos dois primeiros meses, e uma perda significativa de ancoragem do molar foi observada apenas no primeiro mês no lado controle. Não houve diferenças estatisticamente significativas entre os grupos, com relação à percepção da dor e rotação, inclinação, profundidade de sondagem e reabsorção radicular do canino. Conclusões: O uso de plugs de L-PRF em alvéolos pós-extração aumentou consideravelmente a taxa de movimentação do canino apenas nos dois primeiros meses, não sendo observada uma eficácia em longo prazo.

Progress of airway mucus plugs in bronchial asthma / 国际儿科学杂志

Mucus plugs is a feature of fatal asthma, which is the abnormally thick mucus accumulated in the airway of patients.The study of airway mucus plugs in asthmatic patients began 100 years ago.In addition to the manifestation of primary disease, asthma patients with mucus plugs may have acute exacerbation of asthma or poor treatment effect.At this time, we should pay attention to the existence of mucus plugs.Multidetector computed tomography can be used to identify and evaluate mucus plugs.This article briefly describes the generation of airway mucus, and introduces the formation mechanism, clinical characteristics, identification and scoring system of mucus plugs in asthmatic patients, and reviews the differential diagnosis and treatment of mucus plugs.

Predictive factors of refractory Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Mycoplasma pneumoniae is one of the common causes of community-acquired pneumonia in preschool and school-age children.Although it is self-limited in some children, there are still some cases of refractory Mycoplasma pneumoniae pneumonia(RMPP), which are characterized by various intrapulmonary and extrapulmonary complications, such as the formation of bronchial mucus plugs, necrotizing pneumonia and so on, and even endanger the lives of children.In recent years, with the increase of morbidity of RMPP, some studies have shown that early use of corticosteroids can significantly relieve its clinical symptoms and improve prognosis.Therefore, it is essential to understand the pathogenesis of Mycoplasma pneumoniae pneumonia, identify the high risk factors for predicting RMPP and its associated complications, and then formulate relevant prediction scales.

Silicone perforated punctal plugs for the treatment of punctal stenosis / Tampões perfurados de silicone no tratamento da estenose do ponto lacrimal

ABSTRACT Purpose: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. Methods: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. Results: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. Conclusion: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months.

RESUMO Objetivo: A estenose punctal pode resultar em sintomas como a epífora e diminuir significativamente a qua­lidade de vida dos pacientes. A inserção de um tampão perfurado é um procedimento fácil que é comumente usado como o primeiro passo do tratamento para a estenose punctal. Métodos: Dados clínicos, demográficos e de resultado foram coletados retrospectivamente de 54 olhos de 21 homens e 11 mulheres que consecutivamente se apresentaram em nossa Clínica de Oculoplástica e foram submetidos a inserção de um tampão de silicone perfurado Micro Flow. Todos os pacientes tinham epífora com estenose punctal. Resultados: Dos 54 tampões, 26 (48,1%) foram perdidos e 28 (51,8%) permaneceram no local. Destes últimos, 8 foram removidos devido a oclusão do tampão com secreção e conjuntivite recorrente, além disso, 2 migraram profundamente no canalículo vertical. Dos 54 tampões, apenas 18 (33,3%) foram bem tolerados com significativa melhora dos sintomas. Conclusão: A perda de tampões é um problema de destaque em pacientes implantados com tampões perfurados. Tampões de silicone falharam em 66,7% dos pacientes durante um seguimento médio de 14,2 meses.

Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

PURPOSE: Bioprosthetic plugs are appealing, allow simple, repeatable applications, preserve sphincter integrity, minimize patient discomfort, and allow subsequent surgical options when needed. However, success rates vary widely. This study assessed the healing rate in our department when both the Cook-Surgisis and the Gore fistula plugs were used and the long-term effectiveness of using anal plugs for managing anal fistulae. METHODS: A chart review was performed for patients who had undergone plug insertion between January 2008 and December 2015 at Copenhagen University Hospital, Hvidovre. Data were collected through a prospectively collected database. Plugs were inserted according to guidance provided by 2 experienced surgeons. Long-term results were determined by clinical visits 3, 6, and 12 months after surgery and once yearly thereafter. RESULTS: From 2008 to 2015, 36 fistula plugs were inserted. During the follow-up period with a median duration of 18 months (range, 7–60 months), the fistulae of 52.8% of the patients healed. The plug failure rate was 44.4%, and the fistula recurrence rate was 26.3%. The median time to recurrence was 12 months. The overall success rate for plug treatment in our department was 39% when adjusted for recurrence. CONCLUSION: The use of bioprosthetic plugs to treat patients with complex anal fistulae seems to be a safe, viable option for complex fistula repair when other surgical attempts have failed. However, it should not be the treatment of choice. Further prospective randomized studies with a sufficient sample-size and standardized measurements are necessary to evaluate the efficacy of fistula plugs fully.

A comparative study about the time of pregnancy and gestational age of SD rats by three methods / 中国基层医药

Objective To explore more accurate method about the time of pregnancy and gestational age of SD rats.Methods 7 to 8-week-old SD rats (18 females,6 males) were selected,the ratios of male to female were 2:1,5:2,1:1 and 4:1.Through vaginal plug observation,vaginal smear method,weight comparison method to verify the exact date of pregnancy in the next morning.Results Vaginal observed at milky vaginal plug sperm could be observed as sickle rat sperm head.Body weight of pregnant rats changed obviously.Three detection methods were used to detect the pregnancy time for 18 females.The positive rate of vaginal plug observation was 5.6％.The positive rate of vaginal smear method was 44.4％.The false negative rate of vaginal smear method was 11.1％.The positive rate of body weight method was 11.1％.The false positive rate was 5.6％.Conclusion The accuracy of vaginal smear is higher than the vaginal plug method and weight comparison method,the vaginal plug method can be used as the premise of the other two methods.Comparison method can be used as supplementary that the other two methods missed.

A review of 42 asthmatic children with allergic bronchopulmonary aspergillosis

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves. OBJECTIVE: To highlight the presentation of ABPA in children with asthma. METHODS: This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS. RESULTS: Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis. CONCLUSION: This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.

Management of punctal occlusion post - viral conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To evaluate the effect of different methods in managing punctual and canalicular stenosis as a complication of viral conjunctivitis. ?METHODS: A retrospective cohort study, including 35 cases of punctal stenosis post-viral conjunctivitis. Cases were diagnosed clinically and treated after 4wk of complete remission from epidemic keratoconjunctivitis. Patients were treated with mechanical dilatation, insertion of perforated silicon punctual plugs or the use of Mini-Monoka stent. ?RESULTS: Six out of 35 ( 17. 14%) had a satisfactory outcome by punctal dilatation alone. Punctal dilatation with insertion of perforated punctal plugs was done in 20 cases ( 57. 14%). Nine cases ( 25. 71%) had punctal dilatation with Mini - Monoka tube insertion. Disease severity and the use of Mini-Monoka silicon tube did not correlate with bilateral eye involvement or involvement of both upper and lower punctum. ?CONCLUSlON: Management of punctal occlusion post viral conjunctivitis may be treated easily using perforated punctal plugs. Silicon intubation with Mini-Monoka might be needed to manage resistant cases.

Research progress of artificial anus plugging device in the treatment of fecal incontinence / 国际外科学杂志

Colostomy,which is an important means of surgical treatment of colorectal cancer,leads to the colostomy fecal leakage,odor,skin infections and other complications.Artificial anus plugging device as an alternate device to colostomy bag,can achieve bowel control,streamline operations,good blocking effect and mprove the quality of life.Therefore,in this review,the author will discuss the research progress of artificial anus plugging device,including its froms,materials and functions in the treatment of fecal incontinence.

Effect of different culture tube caps and concentrations of activated charcoal and sucrose on in vitro growth and budding induction of Annona glabra L. / Efeito do tipo de selamento do recipiente de cultura, diferentes concentrações de carvão ativado e sacarose na indução e crescimento de brotações in vitro de Annona glabra L.

The present work evaluated the effects of different types of culture flask seals and varying concentrations of sucrose and activated charcoal on the in vitro induction and growth of buds of Annona glabra L.; an edible fruit-producing species popularly known as "araticum". Nodal segments obtained from A. glabra plants maintained in green houses were surface sterilized and inoculated into a WPM culture medium solidified with 7 g L-1 of agar and supplemented with sucrose (0.00; 29.21; 58.63 and 116.84 mM), activated charcoal (0.0 and 2.0 g L-1), and 250 mg L-1 benomyl. In addition to the varying concentrations of sucrose and activated charcoal, we evaluated the efficiency of two types of test tube seals: PVC film, and cotton plugs. All possible combinations of caps and nutrient media were tested with 4 repetitions with 5 tubes each, evaluating the number of buds, the percentage of explant responses, the number of expanded leaves per bud, the length of the largest leaves, leaf abscission, and the length and dry weight of the buds. The type of seal influenced organogenesis in nodal segments of A. glabra, and no bud induction was observed in the absence of sucrose. The largest number of expanded leaves were obtained when 58.42 mM of sucrose was used in tubes sealed with cotton plugs, and leaf abscission was halved in the presence of activated charcoal. The greatest bud length and dry weight were obtained in tubes sealed with cotton plugs and in the presence of activated charcoal.

Este trabalho foi realizado com o objetivo de avaliar o efeito do tipo de selamento do recipiente de cultura e diferentes concentrações de sacarose e carvão ativado na indução e crescimento de brotações in vitro de Annona glabra L.; espécie frutífera conhecida popularmente como araticum. Segmentos nodais obtidos de plantas de A. glabra mantidas em casa de vegetação, após o processo de assepsia, foram inoculados em meio de cultura WPM com 7 g L-1 de agar e sacarose (0,00; 29,21; 58,63 e 116,84 mM) combinado com carvão ativado (0,0 e 2,0 g L-1) e 250 mg L-1 de benomil. Avaliaram-se dois tipos de selamento nos tubos de ensaio: tampa com película de PVC e tampão de algodão. O experimento foi instalado em DIC em arranjo fatorial 4x2x2, com 4 repetições/5 tubos por parcela. Avaliou-se o número brotações, a porcentagem de explantes responsivos, o número de folhas expandidas por brotação, o comprimento da maior folha, a abscisão foliar, o comprimento e a matéria seca das brotações. O tipo de selamento influenciou a organogênese em segmentos nodais de A. glabra. Contudo, não houve indução de brotações na ausência de sacarose. O maior número de folhas expandidas foi obtido quando utilizou-se 58,42 mM de sacarose em tubos selados com tampão de algodão e a abscisão foliar foi reduzida à metade na presença do carvão ativado. Maiores comprimentos e maiores pesos da matéria seca das brotações foram obtidos em tubos selados com tampão de algodão, também na presença de carvão ativado.

Utilidad del botón septal y nivel de satisfacción obtenido en los pacientes con perforaciones del septum: nuestra experiencia / Septal button utility and level of satisfaction obtained in patients with drilling septal: our experience

Introducción: La mayoría de las perforaciones septales suelen ser asintomáticas, aunque algunas pueden presentar una rinitis costrosa, obstrucción nasal, epistaxis recidivante o sibilancias nasales. Su origen es sobre todo iatrogénico o idiopático, pero también podemos encontrar otras causas. Los botones septales constituyen una solución útil por la sencillez de su colocación, siendo de elección en pacientes que no deseen una intervención quirúrgica más compleja. Objetivo: Conocer las características de las perforaciones septales, además de, realizar un estudio sobre los resultados obtenidos en la cirugía de botón septal y el nivel de satisfacción obtenido por los pacientes tras esta intervención. Material y método: Análisis retrospectivo de 22 pacientes intervenidos quirúrgicamente de colocación de botón septal entre enero de 2008 a agosto 2010 en el Hospital Clínico Universitario Lozano Blesa de Zaragoza. El análisis incluye un estudio sobre la etiología, tamaño y sintomatologia de dichas perforaciones candidatas a la utilización del botón septal. Además del análisis de la presencia o ausencia de complicaciones tras la cirugía, la evolución y la mejoría o empeoramiento posoperatorio, en cuanto a los cinco síntomas principales; obstrucción nasal, las sibilancias, las costras endonasales con sequedad, la epistaxis y la rinorrea con tres posibles respuestas; igual, mejor o peor. En el consultorio y a los tres meses de la intervención, se realiza una encuesta con una escala analógica visual (EVA), en la que el paciente realiza una puntuación subjetiva del 1 al 10 para valorar su nivel de satisfacción tras la colocación del obturador Por último se le pregunta si volvería a ponérselo. Los resultados no fueron analizados con pruebas estadísticas dado el pequeño tamaño muestral. Resultados: Nuestros pacientes han presentado una importante mejoría en síntomas como la obstrucción nasal...

Introduction: Most of the septal perforations are usually asymptomatic, although some may have a crusty rhinitis, nasal obstruction, recurrent epistaxis or nasal wheeze. Its origin is mostly iatrogenic or idiopathic but can also find other causes. Septal buttons are a useful solution for the simplicity of their placement, being of choice in patients who do not want surgery more complex. Aim: Knowing the characteristics of septal perforations, in addition, a study on the results of septal button surgery and the level of satisfaction obtained by patients after the intervention. Material and method: Retrospective analysis of 22 patients with surgical septal button surgical placement between January 2008 to August 2010 at the Hospital Clinico Universitario Lozano Blesa from Zaragoza. The analysis includes a study on the etiology, symptoms of such size and drilling candidates for the use of septal button. Besides the analysis of the presence or absence of complications after surgery, and postoperative improvement or worsening in the five main symptoms, stuffy, nose, wheezing, endonasal crust with dryness, epistaxis and rhinorrhea with three possible answers, same, better or worse. Three months after surgery in the office is conducting a survey with a visual analogue scale (VAS), in which the patient makes a subjective score of 1 to 10 to assess their level of satisfaction after the placement of the shutter. Finally asked if he would wear it. The results were analyzed with statistical tests given the small sample size. Results: Our patients have experienced a significant improvement in symptoms such as nasal obstruction and wheezing. Nasal dryness has been with worse clinical outcomes after placement of the button. Subjectively 77.2(0) percent of patients would put him back. Conclusions: The septal buttons are a therapeutic tool to keep in mind for the closure of septal perforations with good results in patients unsuitable for surgical correction.

Dentin permeability: the basis for understanding pulp reactions and adhesive technology

Permeability involves the passage of fluids, ions, molecules, particulate matter and bacteria into and through a substance or tissue under different and varying conditions. The permeability of the dentin is essential to support the physiology and reaction patterns of the pulp-dentin organ. Nutrients and impulses are transported from the pulp via the odontoblast process and the contents of its tubules maintain the dentin as a vital tissue. However, the main interest of this paper focuses on penetration from the outside towards the pulp rather than from the pulp towards the outside. The present overview centers on the dentinal tubules; how they are formed and how they change as a result of normal and abnormal function, age, and pathological processes and the effect of these processes on the permeability of dentin. Particular attention is focused on the patency of the dentinal tubules.This overview is largely based on the author’s own research, clinical insights and active participation in continuing dental education over the last 50 years. It is not a review of the literature related to the permeability of dentin. Rather it presents interpretation of results related to the permeability of dentin based on experience and opinions acquired over a lifetime in dental research.

A permeabilidade envolve a passagem de fluidos, íons, moléculas, material particulado e bactérias para o interior e através de uma substância ou tecido sob diferentes e variáveis condições. A permeabilidade da dentina é essencial para a fisiologia e para os padrões de reação do órgão dentino-pulpar. Nutrientes e impulsos são transportados a partir da polpa por meio dos processos odontoblásticos e o conteúdo dos seus túbulos mantém a vitalidade da dentina. Entretanto, o principal interesse deste artigo concentra-se na penetração do exterior para a polpa e não da polpa para o exterior. O presente artigo centra-se essencialmente nos túbulos dentinários; como eles são formados e como eles mudam em razão da função normal e anormal, idade e processos patológicos, e o efeito destes processos na permeabilidade da dentina. Especial atenção é dada à patência dos túbulos dentinários. Este artigo apresenta uma visão geral do assunto e baseia-se amplamente nas pesquisas e percepções clinicas do próprio autor e em sua ativa participação na educação odontológica continuada ao longo dos últimos 50 anos. Não se trata de uma revisão da literatura relacionada à permeabilidade dentinária, mas sim da interpretação de resultados relacionados à permeabilidade dentinária com base na experiência e opiniões formadas ao longo de toda uma vida dedicada à pesquisa odontológica.

Pulmonary Lobar Collapse after the Induction of Anesthesia: A Case Report / 대한마취과학회지

Although segmental or subsegmental atelectasis may occur during anesthesia, mucous plugging of a mainstem bronchus has been uncommonly reported in anesthetized patients with chronic respiratory disease. However, pulmonary atelectasis following mucous plugging may rarely result normal patients. We report this case of an allegedly healthy patient was developed a left main stem bronchus obstruction, resulting in subsegmental collapse of left lower lung after the induction of general anesthesia.