In Vitro Characterization of Hydroxyapatite-Based Coatings Doped with Mg or Zn Electrochemically Deposited on Nanostructured Titanium.

Biomaterials are an important and integrated part of modern medicine, and their development and improvement are essential. The fundamental requirement of a biomaterial is found to be in its interaction with the surrounding environment, with which it must coexist. The aim of this study was to assess the biological characteristics of hydroxyapatite (HAp)-based coatings doped with Mg and Zn ions obtained by the pulsed galvanostatic electrochemical method on the surface of pure titanium (cp-Ti) functionalized with titanium dioxide nanotubes (NTs TiO2) obtained by anodic oxidation. The obtained results highlighted that the addition of Zn or Mg into the HAp structure enhances the in vitro response of the cp-Ti surface functionalized with NT TiO2. The contact angle and surface free energy showed that all the developed surfaces have a hydrophilic character in comparison with the cp-Ti surface. The HAp-based coatings doped with Zn registered superior values than the ones with Mg, in terms of biomineralization, electrochemical behavior, and cell interaction. Overall, it can be said that the addition of Mg or Zn can enhance the in vitro behavior of the HAp-based coatings in accordance with clinical requirements. Antibacterial tests showed that the proposed HAp-Mg coatings had no efficiency against Escherichia coli, while the HAp-Zn coatings registered the highest antibacterial efficiency.

Perioperative Analgesia and Patients' Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine.

Perioperative analgesia for cesarean section aims to ensure the mother's comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence of adverse reactions in elective cesarean section under spinal anesthesia when fentanyl or morphine was added to bupivacaine. Two treatment groups comprising 173 subjects were compared in the per-protocol analysis: F (fentanyl, standard dose 25 µg) and M (morphine, standard dose 100 µg). Numerical pain scores were recorded perioperatively for 72 h (both at rest and on mobilization), with overall postoperative satisfaction and analgesic-related side effects. The patients in the morphine group had significantly better pain management (Mann-Whitney U test, p < 0.001) and higher level of satisfaction (Mann-Whitney U test, p < 0.001). The latter was related to the greater need for rescue medication in the fentanyl group (OR = 4.396; p = 0.019). On the other hand, fentanyl had significantly fewer non-life-threatening side effects, such as high-intensity pruritus (Mann-Whitney U test, p < 0.001), nausea (OR = 0.324; p = 0.019), vomiting and dizziness upon first mobilization (OR = 0.256; p < 0.001). It remains for future clinical trials to help establish doses that will tilt the scale to one side or the other.

In Vitro Evaluation of Ag- and Sr-Doped Hydroxyapatite Coatings for Medical Applications.

Osseointegration plays the most important role in the success of an implant. One of the applications of hydroxyapatite (HAp) is as a coating for metallic implants due to its bioactive nature, which improves osteoconduction. The purpose of this research was to assess the in vitro behavior of HAp undoped and doped with Ag and/or Sr obtained by galvanostatic pulsed electrochemical deposition. The coatings were investigated in terms of chemical bonds, contact angle and surface free energy, electrochemical behavior, in vitro biomineralization in acellular media (SBF and PBS), and biocompatibility with preosteoblasts cells (MC3T3-E1 cell line). The obtained results highlighted the beneficial impact of Ag and/or Sr on the HAp. The FTIR spectra confirmed the presence of hydroxyapatite within all coatings, while in terms of wettability, the contact angle and surface free energy investigations showed that all surfaces were hydrophilic. The in vitro behavior of MC3T3-E1 indicated that the presence of Sr in the HAp coatings as a unique doping agent or in combination with Ag elicited improved cytocompatibility in terms of cell proliferation and osteogenic differentiation. Therefore, the composite HAp-based coatings showed promising potential for bone regeneration applications.

Effects of Film Thickness of ALD-Deposited Al2O3, ZrO2 and HfO2 Nano-Layers on the Corrosion Resistance of Ti(N,O)-Coated Stainless Steel.

The goal of this stydy was to explore the potential of the enhanced corrosion resistance of Ti(N,O) cathodic arc evaporation-coated 304L stainless steel using oxide nano-layers deposited by atomic layer deposition (ALD). In this study, we deposited Al2O3, ZrO2, and HfO2 nanolayers of two different thicknesses by ALD onto Ti(N,O)-coated 304L stainless steel surfaces. XRD, EDS, SEM, surface profilometry, and voltammetry investigations of the anticorrosion properties of the coated samples are reported. The amorphous oxide nanolayers homogeneously deposited on the sample surfaces exhibited lower roughness after corrosion attack compared to the Ti(N,O)-coated stainless steel. The best corrosion resistance was obtained for the thickest oxide layers. All samples coated with thicker oxide nanolayers augmented the corrosion resistance of the Ti(N,O)-coated stainless steel in a saline, acidic, and oxidising environment (0.9% NaCl + 6% H2O2, pH = 4), which is of interest for building corrosion-resistant housings for advanced oxidation systems such as cavitation and plasma-related electrochemical dielectric barrier discharge for breaking down persistent organic pollutants in water.

TiSiCN as Coatings Resistant to Corrosion and Neutron Activation.

The aim of the present paper was to evaluate the effect of neutron activation on TiSiCN carbonitrides coatings prepared at different C/N ratios (0.4 for under stoichiometric and 1.6 for over stoichiometric). The coatings were prepared by cathodic arc deposition using one cathode constructed of Ti88 at.%-Si12 at.% (99.99% purity). The coatings were comparatively examined for elemental and phase composition, morphology, and anticorrosive properties in 3.5% NaCl solution. All the coatings exhibited f.c.c. solid solution structures and had a (111) preferred orientation. Under stoichiometric structure, they proved to be resistant to corrosive attack in 3.5% NaCl and of these coatings the TiSiCN was found to have the best corrosion resistance. From all tested coatings, TiSiCN have proven to be the most suitable candidates for operation under severe conditions that are present in nuclear applications (high temperature, corrosion, etc.).

Leuconostoc citreum: A Promising Sourdough Fermenting Starter for Low-Sugar-Content Baked Goods.

This review highlights Leuconostoc citreum's promising possibilities as a proficient mannitol producer and its potential implications for sugar reduction, with a focus on its use in sourdough-based baked good products. Mannitol, a naturally occurring sugar alcohol, has gained popularity in food items due to its low calorie content and unique beneficial qualities. This study summarizes recent research findings and investigates the metabolic pathways and culture conditions that favor increased mannitol production by Leuconostoc citreum. Furthermore, it investigates the several applications of mannitol in baked goods, such as its function in increasing texture, flavor and shelf life while lowering the sugar content. Sourdough-based products provide an attractive niche for mannitol integration, as customer demand for healthier and reduced-sugar options increases.

Norms, prices, and commitment: A comprehensive overview of field experiments in the energy domain and treatment effect moderators.

This paper provides a comprehensive overview of field experiments utilizing social norms, commitment and price-based interventions to promote energy conservation, load shifting, and energy efficiency behaviors. Treatment effects reported in the extant literature, as well as the factors that may strengthen or dampen these effects are reviewed. We find that social norm and incentive-based interventions mostly achieve small reductions in energy consumption, and that the effects of commitment-based interventions are essentially zero for the most part. Incentive effects on energy efficiency investments are mostly non-existent, safe for a few exceptions. One gap that we identify is the almost complete absence of field experiments leveraging social norms or commitment to promote energy efficiency investments. We discuss a broad range of (mostly under-researched) plausible moderators of the interventions' effects. Crucially, a more careful attention to moderators in future research can highlight instances in which interventions can be effective, notwithstanding their modest or non-existent average treatment effects. Our review offers a starting point in this regard.

Development and Evaluation of Copper Based Transparent Heat Reflectors Obtained by Magnetron Sputtering.

Within the next few years climate change is likely to become a major concern for mankind. In addition, the current electronic components shortage crisis has led to an urgent need for alternative solutions in the main industry sectors (the raw materials, manufacturing, and construction industries). The current trends of research are focused on developing smart materials with functional properties, using abundant raw materials. The energy saving efforts are sustained in the glazing industries by several approaches based on dielectric-metal-dielectric multilayer structures. The use of silver to achieve a high reflectivity in near-infrared spectral range has been proposed and is already adopted as a commercially available solution. This work is focused on developing a transparent heat reflector (THR) with prefigured optical properties, using copper as a reflective layer, a material that is more abundant and cheaper than silver. The conductive copper layers obtained by the High Power Impulse Magnetron Sputtering (HiPIMS) method were interposed between two silicon nitride layers deposited by the Radio-Frequency Magnetron Sputtering (RFMS) technique. The structural, optical, and elemental composition of monolayers was investigated, qualifying each individual material for use in the multilayer structure. The time stability of films deposited on microscope glass substrates was also investigated, as an important criterion for the selection of monolayers. The obtained results revealed that the SiNx/Cu/SiNx with the Cu layer deposited by using a negative substrate bias of -100 V showed the most stable behavior over time. Optical modeling was performed to design a THR multilayer structure, which was successfully obtained experimentally. A maximum optical transparency as high as 75% in the visible range and a reflectivity of ~ 85% in near infrared spectral interval was confirmed for the experimentally obtained multilayer structures.

Synthesis and Investigation of Antibacterial Activity of Thin Films Based on TiO2-Ag and SiO2-Ag with Potential Applications in Medical Environment.

Multiple antibiotic resistance has now become a major obstacle to the treatment of infectious diseases. In this context, the application of nanotechnology in medicine is a promising alternative for the prevention of infections with multidrug-resistant germs. The use of silver as a powerful antibacterial agent has attracted much interest. TiO2 and SiO2 thin films enhanced with Ag particles have been developed with the aim of maintaining the transparency of the polymer films. Antibacterial activity was evaluated for a Gram-negative species-Escherichia coli-in concentrations of 105 and 104 CFU/mL in different conditions-activation by UV irradiation, single layer and double layer. Increased antibacterial efficacy of TiO2-deposited foil was found for the tests that had been exposed to UV activation. In the case of bilayer tests, the efficiency was higher compared to those in a single layer, as the contact surface between the films and the bacterial suspension increased. Films can be used as a potential method to limit bacterial growth on hospital surfaces, such as telephone screens and medical equipment, given their optimized characteristics and proven antibacterial efficacy.

Effect of Deep Cryogenic Treatment on Corrosion Behavior of AISI H13 Die Steel.

AISI H13 die steel specimens were subjected to heating at 1020 °C followed by oil quenching and double tempering at 520 °C. Subsequently, these specimens were subjected to deep cryogenic treatment at -185 °C in liquid nitrogen environment for 16 h and then subjected to soft tempering at 100 °C once the specimens attained room temperature. Thereafter, the specimens were subjected to scanning electron microscopy (SEM) analysis and electron backscatter diffraction (EBSD) analysis. The electrochemical corrosion activity was investigated in 3.5% NaCl at 23 ± 0.5 °C by evaluating the evolution of open circuit potential over time and potentiodynamic curves, and electrochemical impedance spectroscopy study was also carried out. The heat-treated specimens exhibited better resistance to corrosion through more electropositive values of open circuit potential. This could be attributed to lower grain boundary area in heat-treated specimens as compared to 16 h cryogenically treated specimen as higher grain boundary areas behave as an anode in an electrochemical cell, thereby enhancing the rate of corrosion. According to electrochemical tests, the cryogenically treated surface is more resistant to corrosion, followed by heated alloy. However, both surface modification treatments improved the corrosion behavior of the untreated alloy.

Macroalgae-A Sustainable Source of Chemical Compounds with Biological Activities.

Nowadays, one of the most important research directions that concerns the scientific world is to exploit the earth's resources in a sustainable way. Considering the increasing interest in finding new sources of bioactive molecules and functional products, many research studies focused their interest on demonstrating the sustainability of exploiting marine macroalgal biomass as feedstock for wastewater treatment and natural fertilizer, conversion into green biofuels, active ingredients in pharmaceutical and nutraceutical products, or even for the production of functional ingredients and integration in the human food chain. The objective of the present paper was to provide an overview on the recent progress in the exploitation of different macroalgae species as a source of bioactive compounds, mainly emphasizing the latter published data regarding their potential bioactivities, health benefits, and industrial applications.

Psychologic impact of follow-up after low-risk gestational trophoblastic disease.

OBJECTIVE: To investigate the psychological consequences of hCG measurements during follow-up in patients with low-risk gestational trophoblastic disease. The length of follow-up of patients with molar pregnancy and spontaneous normalization of the hCG level is currently discussed, in consideration of the low incidence of recurrent disease. STUDY DESIGN: Patients registered in the Dutch Central Registry of Hydatidiform Mole between January 2006 and December 2007 were eligible for this study. Patients received a questionnaire containing questions about follow-up and anxiety and stress during this period. RESULTS: Seventy-six patients were eligible for the study. An inverted correlation (r = -0.35, p = 0.003) was found between the age of patients and the level of anxiety. Anxious patients scored higher for fear of recurrence (r = 0.49, p < 0.0001), of infertility (r = 0.40, p = 0.001) and of conceiving again (r = 0.30, p = 0.01). They experienced the measurements as a burden (r = 0.35, p = 0.003). Fewer patients (24%) were insecure before the monthly hCG measurement, compared to 51% during weekly measurements. The majority of women (80%) completed the follow-up and confirmed that they would come for weekly and monthly hCG measurements if it were optional. CONCLUSION: Follow-up after low-risk GTD has psychologic consequences but provides reassurance as well. Therefore, women tend to accept the offered surveillance and refrain from pregnancy. Women with GTD should be counseled about the minor risk of recurrence and the consequences of follow-up.

The role of chemo-radiotherapy in the management of locally advanced carcinoma of the vulva: single institutional experience and review of literature.

OBJECTIVE: To retrospectively investigate the outcome and toxicity of concurrent chemo-radiotherapy in the treatment of locally advanced vulvar cancer (LAVC). PATIENTS AND METHODS: Between 1996 and 2007, 28 consecutive patients with LAVC were treated with chemoradiation (20 primary tumors and 8 loco-regional recurrences). Treatment consists of 2 separate courses of external-beam radiotherapy (40 Gy-2 weeks split-20 Gy). During each course of radiotherapy, 5-fluorouracil (1000 mg/m/d), was given as a continuous intravenous infusion over the first 4 days, and mitomycin-C (10 mg/m on day 1), as a bolus intravenous injection. Outcome measures were rates of complete and partial response, loco-regional control, progression-free survival, overall survival, and toxicity. RESULTS: The median follow-up was 42 months and the median age of patients was 68 years. Twenty patients (72%) achieved complete remission, 4 patients (14%) partial remission, for an overall response rate of 86%. Four patients (14%) had progressive disease directly after chemo-radiotherapy. The actuarial rates of loco-regional control, progression-free survival and overall survival at 4 years were 75%, 71%, and 65%, respectively. There was no treatment break for acute toxicity. Vulvar desquamation was the main acute treatment-related side effect (93%). Three patients developed transient grade 2 neutropenia or thrombocytopenia. Mild skin fibrosis and atrophy (n = 6, 21%), radiation ulcer (n = 4, 14%, in one patient treatment was needed), telangectasia (n = 3, 11%), and lymphoedema (n = 2, 7%) were the most common late toxicity of chemoradiation. CONCLUSION: These data support the use of concurrent chemoradiotherapy as an effective alternative to primary ultra-radical surgery to treat LAVC with an acceptable toxicity profile.

Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study.

BACKGROUND: Currently, all patients with vulvar cancer with a positive sentinel node undergo inguinofemoral lymphadenectomy, irrespective of the size of sentinel-node metastases. Our study aimed to assess the association between size of sentinel-node metastasis and risk of metastases in non-sentinel nodes, and risk of disease-specific survival in early stage vulvar cancer. METHODS: In the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V), sentinel-node detection was done in patients with T1-T2 (<4 cm) squamous-cell vulvar cancer, followed by inguinofemoral lymphadenectomy if metastatic disease was identified in the sentinel node, either by routine examination or pathological ultrastaging. For the present study, sentinel nodes were independently reviewed by two pathologists. FINDINGS: Metastatic disease was identified in one or more sentinel nodes in 135 (33%) of 403 patients, and 115 (85%) of these patients had inguinofemoral lymphadenectomy. The risk of non-sentinel-node metastases was higher when the sentinel node was found to be positive with routine pathology than with ultrastaging (23 of 85 groins vs three of 56 groins, p=0.001). For this study, 723 sentinel nodes in 260 patients (2.8 sentinel nodes per patient) were reviewed. The proportion of patients with non-sentinel-node metastases increased with size of sentinel-node metastasis: one of 24 patients with individual tumour cells had a non-sentinel-node metastasis; two of 19 with metastases 2 mm or smaller; two of 15 with metastases larger than 2 mm to 5 mm; and ten of 21 with metastases larger than 5 mm. Disease-specific survival for patients with sentinel-node metastases larger than 2 mm was lower than for those with sentinel-node metastases 2 mm or smaller (69.5%vs 94.4%, p=0.001). INTERPRETATION: Our data show that the risk of non-sentinel-node metastases increases with size of sentinel-node metastasis. No size cutoff seems to exist below which chances of non-sentinel-node metastases are close to zero. Therefore, all patients with sentinel-node metastases should have additional groin treatment. The prognosis for patients with sentinel-node metastasis larger than 2 mm is poor, and novel treatment regimens should be explored for these patients.

Primary surgery versus primary radiation therapy with or without chemotherapy for early adenocarcinoma of the uterine cervix.

BACKGROUND: For early squamous cell carcinoma of the uterine cervix, the outcome is similar after either primary surgery or primary radiotherapy. There are reports that this is not the case for early adenocarcinoma (AC) of the uterine cervix: some studies have reported that the outcome is better after primary surgery. There are no systematic reviews about surgery versus chemoradiation in the treatment of cervical cancer. OBJECTIVES: The objectives of this review were to compare the effectiveness and safety of primary surgery for early stage AC of the uterine cervix with primary radiotherapy or chemoradiation. SEARCH STRATEGY: We searched Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2009, MEDLINE (1950 to July week 5, 2009), EMBASE (1980 to week 32, 2009) and we also searched the related articles feature of PubMed and the Web of Science. We also checked the reference lists of articles. SELECTION CRITERIA: Studies of treatment of patients with early AC of the uterine cervix were included. Treatment included surgery, surgery followed by radiotherapy, radiotherapy and chemoradiation. DATA COLLECTION AND ANALYSIS: Forty-three studies were selected by the search strategy and thirty studies were excluded. Twelve studies were considered for inclusion. Except for one randomised controlled trial (RCT), all other studies were retrospective cohort studies with variable methodological quality and had limitations of a retrospective study. Comparing the results from these retrospective studies was not possible due to diverging treatment strategies. MAIN RESULTS: Analysis of a subgroup of one RCT showed that surgery for early cervical AC was better than RT. However, the majority of operated patients required adjuvant radiotherapy, which is associated with greater morbidity. Furthermore, the radiotherapy in this study was not optimal, and surgery was not compared to chemoradiation, which is currently recommended in most centres. Finally, modern imaging techniques, i.e. MR-imaging and PET-CT-scanning, allow better selection of patients and node negative patients can now be more easily identified for surgery, there by reducing the risk of 'double trouble' caused by surgery and adjuvant radiotherapy. AUTHORS' CONCLUSIONS: We recommend surgery for early stage AC of the uterine cervix in carefully staged patients. Primary chemoradiation remains a second best alternative for patients unfit for surgery; chemoradiation is probably first choice in patients with (MRI or PET-CT-suspected) positive lymph nodes.

Sentinel node dissection is safe in the treatment of early-stage vulvar cancer.

PURPOSE: To investigate the safety and clinical utility of the sentinel node procedure in early-stage vulvar cancer patients. PATIENTS AND METHODS: A multicenter observational study on sentinel node detection using radioactive tracer and blue dye was performed in patients with T1/2 (< 4 cm) squamous cell cancer of the vulva. When the sentinel node was found to be negative at pathologic ultrastaging, inguinofemoral lymphadenectomy was omitted, and the patient was observed with follow-up for 2 years at intervals of every 2 months. Stopping rules were defined for the occurrence of groin recurrences. RESULTS: From March 2000 until June 2006, a sentinel node procedure was performed in 623 groins of 403 assessable patients. In 259 patients with unifocal vulvar disease and a negative sentinel node (median follow-up time, 35 months), six groin recurrences were diagnosed (2.3%; 95% CI, 0.6% to 5%), and 3-year survival rate was 97% (95% CI, 91% to 99%). Short-term morbidity was decreased in patients after sentinel node dissection only when compared with patients with a positive sentinel node who underwent inguinofemoral lymphadenectomy (wound breakdown in groin: 11.7% v 34.0%, respectively; P < .0001; and cellulitis: 4.5% v 21.3%, respectively; P < .0001). Long-term morbidity also was less frequently observed after removal of only the sentinel node compared with sentinel node removal and inguinofemoral lymphadenectomy (recurrent erysipelas: 0.4% v 16.2%, respectively; P < .0001; and lymphedema of the legs: 1.9% v 25.2%, respectively; P < .0001). CONCLUSION: In early-stage vulvar cancer patients with a negative sentinel node, the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal. We suggest that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.

Weekly systemic cisplatin plus locoregional hyperthermia: an effective treatment for patients with recurrent cervical carcinoma in a previously irradiated area.

PURPOSE: Patients with recurrent cervical carcinoma within a previously irradiated area respond poorly to chemotherapy. We have treated these patients with simultaneous cisplatin and hyperthermia (CDDP + HT) and investigated response, toxicity, palliative effect and survival. MATERIALS AND METHODS: Between 1992 and 2005 47 patients received CDDP + HT. Response was evaluated by gynaecologic examination and CT-scan. The Common Toxicity Criteria (CTC) were used for evaluation of toxicity and palliative effect. The Kaplan-Meier method was used to estimate survival, and Cox regression analysis to evaluate the influence of prognostic factors. RESULTS: The objective response rate was 55%, palliation was achieved in 74% and operability in 19% of patients. Two patients are currently disease free at 9 years and 18 + months following treatment and 2 remained disease free until death by other causes. The median survival was 8 months and was influenced by duration of disease free interval and tumour diameter. Grade 3-4 haematological toxicity was observed in 36% of patients and renal toxicity was maximum grade 2. CONCLUSION: CDDP + HT results in a high response rate and acceptable toxicity in patients with recurrent cervical cancer.