In-vitro comparison of hydroxyapatite coatings obtained by cold spray and conventional thermal spray technologies.

Hydroxyapatite (HA) coatings onto Ti6Al4V alloy substrates were obtained by several thermal spray technologies: atmospheric plasma spray (APS) and high velocity oxy fuel (HVOF), together with the cold spray (CS) technique. A characterization study has been performed by means of surface and microstructure analyses, as well as biological performance. In-vitro tests were performed with primary human osteoblasts at 1, 7 and 14 days of cell culture on substrates. Cell viability was tested by MTS and LIVE/DEAD assays, cell differentiation by alkaline phosphatase (ALP) quantification, and cell morphology was analyzed by scanning electron microscopy. The HA coatings showed an increase of HA crystallinity from 62,4% to 89%, but also an increase of hydrophilicity from ∼32° to 0°, with the decrease of the operating temperature of the thermal spray techniques (APS > HVOF > CS). Additionally, APS HA coatings showed more surface micro-features than HVOF and CS HA coatings; cells onto APS HA coatings showed faster attachment by acquiring osteoblastic morphology in comparison with the rounded cell morphology observed onto CS HA coatings at 1 day of cell culture. HVOF HA coatings also showed proper cell adherence but did not show extended filopodia as cells onto APS HA coatings. However, at 14 days of cell culture, higher cell proliferation and differentiation was detected on HA coatings with higher crystallinity (HVOF and CS techniques). Cell attachment is suggested to be favoured by surface micro-features but also moderate surface wettability whereas cell proliferation and differentiation is suggested to be highly influenced by HA crystallinity and crystal size.

X-ray microtomographic characterization of highly rough titanium cold gas sprayed coating for identification of effective surfaces for osseointegration.

A highly rough titanium coating obtained by Cold Gas Spray (CGS) has been characterized by means of high-resolution 3D microtomography (micro-CT) with the aim to evaluate its open and close porosity for possible use in orthopaedic implants to promote osseointegration. Micro-CT allowed a qualitative and quantitative description of the main features, morphology of the pores and surface roughness of the coating. Several numerical values were obtained to describe size, form and distribution of the closed/inner and open/outer pores. Additionally, surface roughness and open porosity were image-analyzed to find the effective surface for osseointegration.

In-vitro study of hierarchical structures: Anodic oxidation and alkaline treatments onto highly rough titanium cold gas spray coatings for biomedical applications.

Hierarchical structures were obtained applying two different nanotexturing surface treatments onto highly rough commercial pure titanium coatings by cold spray: (i) anodic oxidation and (ii) alkaline treatments. An extended surface characterization in terms of topography, composition, and wettability has been performed to understand how those parameters affect to cell response. Primary human osteoblasts extracted from knee were seeded onto the as-sprayed titanium surface before and after the nanotexturing treatments. Cell viability was tested by using MTS and LIVE/DEAD assays, as well as osteoblasts differentiation by alkaline phosphatase (ALP) quantification at 3 and 10 days of cell culture. The combination of micro-/nano-roughness results in a significantly increase of cell proliferation, as well as cell differentiation after 10 days of cell culture in comparison with the non-treated coatings.

Functionalized coatings by cold spray: An in vitro study of micro- and nanocrystalline hydroxyapatite compared to porous titanium.

Three different surface treatments on a Ti6Al4V alloy have been in vitro tested for possible application in cementless joint prosthesis. All of them involve the novelty of using the Cold Spray technology for their deposition: (i) an as-sprayed highly rough titanium and, followed by the deposition of a thin hydroxyapatite layer with (ii) microcrystalline or (iii) nanocrystalline structure. Primary human osteoblasts were extracted from knee and seeded onto the three different surfaces. Cell viability was tested by MTS and LIVE/DEAD assays, cell differentiation by alkaline phosphatase (ALP) quantification and cell morphology by Phalloidin staining. All tests were carried out at 1, 7 and 14 days of cell culture. Different cell morphologies between titanium and hydroxyapatite surfaces were exhibited. At 1 day of cell culture, cells on the titanium coating were spread and flattened, expanding the filopodia actin filaments in all directions, while cells on the hydroxyapatite coatings showed round like-shape morphology due to slower attachment. Higher cell viability was detected at all times of cell culture on titanium coating due to a better attachment at 1 day. However, from 7 days of cell culture, cells on hydroxyapatite showed good attachment onto surfaces and highly increased their proliferation, mostly on nanocrystalline, achieving similar cell viability levels than titanium coatings. ALP levels were significantly higher in titanium, in part, because of greatest cell number. Overall, the best cell functional results were obtained on titanium coatings whereas microcrystalline hydroxyapatite presented the worst cellular parameters. However, results indicate that nanocrystalline hydroxyapatite coatings may achieve promising results for the faster cell proliferation once cells are attached on the surface.

Osteoblastic cell response on high-rough titanium coatings by cold spray.

Highly rough and porous commercially pure titanium coatings have been directly produced for first time by the cold spray technology, which is a promising technology in front of the vacuum plasma spray for oxygen sensitive materials. The wettability properties as well as the biocompatibility evaluation have been compared to a simply sand blasted Ti6Al4V alloy substrate. Surface topographies were analysed using confocal microscopy. Next, osteoblast morphology (Phalloidin staining), proliferation (MTS assay), and differentiation (alkaline phosphatase activity) were examined along 1, 7 and 14 days of cell culture on the different surfaces. Finally, mineralization by alizarin red staining was quantified at 28 days of cell culture. The contact angle values showed an increased hydrophilic behaviour on the as-sprayed surface with a good correlation to the biological response. A higher cell viability, proliferation and differentiation were obtained for highly rough commercial pure titanium coatings in comparison with sand blasted substrates. Cell morphology was similar in all coatings tested; at 14 days both samples showed extended filopodia. A higher amount of calcium-rich deposits was detected on highly rough surfaces. In summary, in-vitro results showed an increase of biological properties when surface roughness increases.

Real-Time Protein and Cell Binding Measurements on Hydroxyapatite Coatings.

Although a lot of in vitro and in vivo assays have been performed during the last few decades years for hydroxyapatite bioactive coatings, there is a lack of exploitation of real-time in vitro interaction measurements. In the present work, real-time interactions for a plasma sprayed hydroxyapatite coating were measured by a Multi-Parametric Surface Plasmon Resonance (MP-SPR), and the results were compared with standard traditional cell viability in vitro assays. MP-SPR is proven to be suitable not only for measurement of molecule-molecule interactions but also molecule-material interaction measurements and cell interaction. Although SPR is extensively utilized in interaction studies, recent research of protein or cell adsorption on hydroxyapatite coatings for prostheses applications was not found. The as-sprayed hydroxyapatite coating resulted in 62.4% of crystalline phase and an average thickness of 24 ± 6 µm. The MP-SPR was used to measure lysozyme protein and human mesenchymal stem cells interaction to the hydroxyapatite coating. A comparison between the standard gold sensor and Hydroxyapatite (HA)-plasma coated sensor denoted a clearly favourable cell attachment on HA coated sensor as a significantly higher signal of cell binding was detected. Moreover, traditional cell viability and proliferation tests showed increased activity with culture time indicating that cells were proliferating on HA coating. Cells show homogeneous distribution and proliferation along the HA surface between one and seven days with no significant mortality. Cells were flattened and spread on rough surfaces from the first day, with increasing cytoplasmatic extensions during the culture time.

Improved bonding strength of bioactive cermet Cold Gas Spray coatings.

The fabrication of cermet biocompatible coatings by means Cold Gas Spray (CGS) provides prosthesis with outstanding mechanical properties and the required composition for enhancing the bioactivity of prosthetic materials. In this study, hydroxyapatite/Titanium coatings were deposited by means of CGS technology onto titanium alloy substrates with the aim of building-up well-bonded homogeneous coatings. Powders were blended in different percentages and sprayed; as long as the amount of hydroxyapatite in the feedstock increased, the quality of the coating was reduced. Besides, the relation between the particle size distribution of ceramic and metallic particles is of significant consideration. Plastic deformation of titanium particles at the impact eased the anchoring of hard hydroxyapatite particles present at the top surface of the coating, which assures the looked-for interaction with the cells. Coatings were immersed in Hank's solution for 1, 4 and 7 days; bonding strength value was above 60 MPa even after 7 days, which enhances common results of HAp coatings obtained by conventional thermal spray technologies.

In vitro performance of ceramic coatings obtained by high velocity oxy-fuel spray.

Hydroxyapatite coatings obtained by plasma-spraying have been used for many years to improve biological performance of bone implants, but several studies have drawn attention to the problems arising from high temperatures and the lack of mechanical properties. In this study, plasma-spraying is substituted by high velocity oxy-fuel (HVOF) spray, with lower temperatures reached, and TiO2 is added in low amounts to hydroxyapatite in order to improve the mechanical properties. Four conditions have been tested to evaluate which are those with better biological properties. Viability and proliferation tests, as well as differentiation assays and morphology observation, are performed with human osteoblast cultures onto the studied coatings. The hydroxyapatite-TiO2 coatings maintain good cell viability and proliferation, especially the cases with higher amorphous phase amount and specific surface, and promote excellent differentiation, with a higher ALP amount for these cases than for polystyrene controls. Observation by SEM corroborates this excellent behaviour. In conclusion, these coatings are a good alternative to those used industrially, and an interesting issue would be improving biological behaviour of the worst cases, which in turn show the better mechanical properties.

Enhancing the bioactivity of polymeric implants by means of cold gas spray coatings.

Nanostructured anatase coatings were built-up on biocompatible polyetheretherketone (PEEK) by means of cold gas spray (CGS). Titanium layer was previously desposited, which acted as bond coat between PEEK and metal oxide. Semicrystalline polymer was not degraded during the spraying process and starting composition of titanium dioxide was not affected. TiO2 was homogeneously obtained onto CGS Ti layer and completely covered the piece. Primary human osteoblasts were seeded onto biomaterials and in vitro cell experiments provided evidence to confirm that nanostructured anatase coatings deposited by cold gas spray improve the performance of PEEK implants.

Smell training increases cognitive smell skills of wine tasters compared to the general healthy population. The WINECAT Study.

BACKGROUND: Wine experts show higher accuracy than novices in selecting a wine that matches a sample. Only one study has compared wine experts with non-trained healthy controls on smell. The aim of this study was to compare the smell characteristics, both sensorial and cognitive, of wine tasters with Spanish healthy population using the Barcelona Smell Test-24. METHODS: Wine tasters were tested for smell and compared with a control group of healthy volunteers, by tasting 20 odours and scoring smell detection, identification, intensity, irritability, freshness, pleasure and forced choice. RESULTS: Wine tasters performed significantly better on identification and forced choice than healthy controls. In addition, wine tasters perceived more odours as intense, but fewer as irritating than controls. CONCLUSIONS: Probably linked to smell education, wine tasters show better cognitive but not sensorial smell skills than a non-trained healthy population.

Accuracy of acoustic rhinometry versus computed tomography in the evaluation of nasal cavity in patients with nasal polyposis.

BACKGROUND: Acoustic rhinometry (AR) accuracy in the diagnosis and follow-up of nasal polyps is as yet unclear. Our objective was to study its accuracy compared with computed tomography (CT) in patients with nasal polyps. METHODS: We studied 29 patients diagnosed of nasal polyposis by nasal endoscopy. In all patients sinunasal CT-scan, AR and nasal nitric oxide (NO) were assessed. Nasal volumes between 0 and 5 (V(0-5)) and 5 and 9 (V(5-9)) centimetres from nasal inlet were measured with AR and CT-scan, by using Pearson and intraclass correlation coefficient tests. RESULTS: All patients (29,79% males, mean age 48.2 yr [range 34-61]) had nasal polyps (score 2-3 on Lildholdt classification, score 0-3). Measurements (right plus left sides) were: AR 8.9 +/- 0.8 cm(3) (V(0-5)) and 15.5 +/- 3.6 cm(3)(V(5-9)); CT 6.5 +/- 0.4 cm(3) (V(0-5)) and 6.3 +/- 0.8 cm(3) (V(5-9)). Pearson correlation was r = 0.67 (p < 0.01) for V(0-5) and r = 0.62 (p < 0.05) for V(5-9). Intraclass correlation coefficient test was 0.51 (V(0-5)) and 0.28 (V(5-9)) for consistency; and 0.43 (V(0-5)) and 0.23 (V(5-9)) for absolute agreement. Low levels of NO (312.3 +/- 43.8 ppb) were found and the correlation between NO levels and volumes (V(0-5) or V(0-9)) measured by AR was not statistically significant. CONCLUSIONS: Compared to CT-scan, AR measurements accurately reflect the geometry of nasal cavity volumes in patients with nasal polyps, with a better assessment in the anterior part of the nasal cavity.

United airways: the impact of chronic rhinosinusitis and nasal polyps in bronchiectasic patient's quality of life.

BACKGROUND: The nose and the bronchi belong, in anatomical and physiopathological terms, to the concept of united airways. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis (NP) and asthma, chronic rhinosinusitis (CRS) and chronic obstructive pulmonary disease, and more recently CRS/NP and bronchiectasis (BQ). OBJECTIVE: To evaluate the impact of CRS on quality of life (QoL) of patients with BQ, and to correlate these findings with the pulmonary status, nasal symptoms, and general health status. METHODS: In a prospective study, patients with BQ (n = 80) were evaluated for CRS and NP using EP(3)OS criteria, and severity of BQ using chest high resolution computed tomography (HRCT)-scan. Quality of life was assessed in all patients by using specific [Sinonasal Outcome Test-20 (SNOT-20), St George Respiratory Questionnaire (SGRQ)], and generic (Short Form-36; SF-36) questionnaires. RESULTS: Using SNOT-20, patients with CRS had worse QoL (2.1 +/- 0.1; P < 0.001) than patients without CRS (0.4 +/- 0.06). Using SGRQ total score, patients with CRS had worse QoL (43.7 +/- 2.2; P < 0.001) than patients without CRS (24.7 +/- 2.5). Using SF-36, patients with CRS had worse QoL, both in the physical summary (64 +/- 3.4; P < 0.05) and the mental summary (65.5 +/- 4.7; P < 0.05), than patients without CRS (physical summary [PS]: 76.2 +/- 3.3; mental summary [MS]: 78.3 +/- 5.3, respectively). Sinonasal Outcome Test-20 was correlated with SGRQ total score (r = 0.72; P < 0.01), and SF-36 physical summary (r = -0.63; P < 0.01). St George Respiratory Questionnaire was correlated with SF-36 on physical summary (r = -0.58; P < 0.05) and with forced expiratory volume in 1 s (r = -0.41; P < 0.05). CONCLUSION: These results suggested that CRS, measured by both specific and generic questionnaires, has a considerable impact on the QoL of patients with BQ.

United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis.

BACKGROUND: Although various relationships between the lower and upper airways have been found, the association of bronchiectasis with chronic rhinosinusitis and nasal polyps has not been thoroughly evaluated. This study was undertaken to examine the association of idiopathic and postinfective bronchiectasis with chronic rhinosinusitis and nasal polyposis. METHODS: In a prospective study, 56 patients with idiopathic and 32 with postinfective bronchiectasis were evaluated for chronic rhinosinusitis and nasal polyposis by using EP(3)OS criteria and assessing: symptoms score, nasal endoscopy, sinonasal and chest CT scan, nasal and lung function and nasal and exhaled NO. RESULTS: Most bronchiectasis patients (77%) satisfied the EP(3)OS criteria for chronic rhinosinusitis, with anterior (98.5%) and posterior (91%) rhinorrhea and nasal congestion (90%) being the major symptoms. Patients presented maxillary, ethmoidal and ostiomeatal complex occupancy with a total CT score of 8.4 +/- 0.4 (0-24). Using endoscopy, nasal polyps with a moderate score of 1.6 +/- 0.1 (0-3) were found in 25% of patients. Nasal NO was significantly lower in patients with nasal polyposis (347 +/- 62 ppb) than in those without them (683 +/- 76 ppb; P < 0.001), and inversely correlated (R = -0.36; P < 0.01) with the ostiomeatal complex occupancy. In the chest CT scan, patients with chronic rhinosinusitis showed a higher bronchiectasis severity score (7.2 +/- 0.5; P < 0.001) than patients without (3.7 +/- 0.7). The prevalence of chronic rhinosinusitis, nasal polyps and other outcomes were similar in idiopathic and postinfective bronchiectasis. CONCLUSIONS: The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.

Is there an overlap between sudden neurosensorial hearing loss and cardiovascular risk factors?

INTRODUCTION: Sudden sensorineural hearing loss (SSHL) has been proposed as a symptom of underlying vascular problems. The purpose of this work is to evaluate the genetic and acquired risk factors. METHODS: Ninety-nine patients were tested for the presence of common polymorphisms related to thrombophilia (prothrombin and factor V Leiden) in order to assess genetic risk factors, and several parameters classically associated with vascular disorders (cardiovascular events, brain stroke and antiphospholipid syndrome) were evaluated. Additional assessments of personal and familial history risk factors for vascular disorders were performed in each patient. RESULTS: Thrombophilia studies did not demonstrate statistically relevant differences between the patients and control group. However, lipidemia profile and directed personal and familial histories showed positive trends for SSHL. CONCLUSION: The lack of clear relationships between SSHL and other vascular risk factors suggests multicausality as a predominant disease profile. Although preliminary results point at a vascular involvement in SSHL, a long-term prospective study is necessary to demonstrate that SSHL represents an early vascular symptom.

[Diagnosis and treatment of chronic epiphora and recurrent dacryocystitis]. / Diagnostik und Therapie von chronischer Epiphora und rezidivierender Dakryozystitis.

The goal of this article is to highlight relevant diagnostic tools to assess chronic epiphora and recurrent dacryocystitis in order to avoid unnecessary diagnostic explorations. Probing of the canaliculi is important for the differential diagnosis of chronic epiphora. Surgical steps are detailed, such as the inferiorly based mucosal flap on the AGGER NASI, which is repositioned at the end of the surgery improving wound healing on the lateral wall. Potential complications are presented, as well as measures to avoid and to treat them. Long-term follow-up of 750 endoscopic DCR confirms the good results in more than 90% after endoscopic dacryocystorhinostomies in adults and in children.

Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1-T4 pharyngo-laryngeal cancers.

Histological affected or close margin is an adverse factor in conventional surgery of larynx-hypopharynx cancer. Our objective was to analyze the relevance of the margins in transoral laser microsurgery (TLM). A retrospective study of 357 consecutive patients with cancer of the larynx and hypopharynx (T1-T4) treated with TLM. Three possible margins were considered: tumor free, affected, and uncertain. An affected margin showed marked tumor infiltration. An uncertain margin was defined when the sample was insufficient, when it showed carbonization impeding accurate evaluation, or when tumor cells were less than 2 mm. Margins were free in 254 (71.1%) patients, affected in 64 (17.9%) and uncertain in 39 (10.9%). One hundred and three patients (28.9%) presented tumor relapse. The margins were associated with tumor relapse (P < 0.001), but were not significantly related to the tumor site (P = 0.307), the pT classification (P = 0.183), or the difficulty of surgical exposure (P = 0.427). Distant metastases were found in 4.7% of the patients with free margins, in 7.7% of those with uncertain margins, and in 14.1% with affected margins. These differences were statistically significant (P = 0.028). Tumor involvement of the surgical margin was associated with higher rates of local relapse, distant metastasis and the necessity of salvage surgery, together with a lower specific actuarial survival rate.

The impact of bronchiectasis associated to sinonasal disease on quality of life.

BACKGROUND: Bronchiectasis (BQs) is an uncommon disease with the potential to cause devastating complications. All patients with BQs have cough and chronic sputum production that may have a great impact on patient's quality of life. Upper airway symptoms are also frequent in patients with BQs. Associations between upper and lower airways diseases have been demonstrated in allergic rhinitis and asthma, nasal polyposis and asthma, chronic obstructive lung disease and chronic rhinosinusitis. OBJECTIVE: (1) To investigate the impact of bronchiectasis and nasal symptoms on quality of life. (2) To evaluate the added impact of nasal polyposis on quality of life in patients with BQs. METHODS: Sixty patients with bronchiectasis and upper airway symptoms were included. Patients were evaluated for nasal symptoms, nasal polyp size by endoscopy, and quality of life using the SF-36 generic questionnaire. RESULTS: In comparison with the Spanish general population, patients with BQs had worse scores in all SF-36 domains (P<0.05). Males reported significantly higher quality of life scores on physical functioning and social functioning than females did. Although the age, pulmonary function, presence of nasal polyps, upper airway symptoms, tobacco smoking history, and disease duration was similar between them. Males with BQs had worse quality of life than males from the Spanish general population on body pain, general health, and vitality (P<0.05). Females with BQs had worse quality of life than females from the Spanish general population on physical function, body pain, general health, vitality, social function, and emotional role (P<0.05). Nasal polyps were found in 25 (41.6%) of 60 patients with BQs. No significant differences were observed on quality of life outcomes between patients with BQs with and without nasal polyposis. CONCLUSION: These results suggest that BQs has a considerable impact on quality of life while nasal polyposis has no additional impact on the quality of life of patients with BQs.

[Relation between rhinosinusitis and bronchiectasis]. / Relaciones entre rinosinusitis y bronquiectasias.

The nose and lungs have both histological and functional similarities and differences. Sinonasal and bronchial involvement are associated in many diseases. Cystic fibrosis, primary ciliary dyskinesia, Young's syndrome, and alpha-1 antitrypsin deficiency are diseases in which bronchiectasis and rhinosinusitis are both present. This review considers the diseases in which bronchiectasis occurs along with sinonasal manifestations. We propose examining sinonasal disease from a new perspective by observing it in patients with bronchiectasis.

Relaciones entre rinosinusitis y bronquiectasias / Relation between rhinosinusitis and bronchiectasis

La nariz y el bronquio presentan similitudes y diferencias tanto histológicas como funcionales. Son muchas las enfermedades en que se asocian la afección nasosinusal y la bronquial. La fibrosis quística, la discinesia ciliar primaria, el síndrome de Young y el déficit de alfa-1-antitripsina son enfermedades en las que se asocian bronquiectasias y rinosinusitis. En este artículo se realiza una revisión de las bronquiectasias y de las enfermedades que las asocian junto a afección nasosinusal. El propósito es dar un nuevo enfoque de la patología nasosinusal observada en los pacientes afectados de bronquiectasias

The nose and lungs have both histological and functional similarities and differences. Sinonasal and bronchial involvement are associated in many diseases. Cystic fibrosis, primary ciliary dyskinesia, Young's syndrome, and á-1 antitrypsin deficiency are diseases in which bronchiectasis and rhinosinusitis are both present. This review considers the diseases in which bronchiectasis occurs along with sinonasal manifestations. We propose examining sinonasal disease from a new perspective by observing it in patients with bronchiectasis

Does Helicobacter pylori have a pathogenic role in bronchiectasis?

AIM: To investigate the presence of Helicobacter pylori (H. pylori) in bronchial biopsies of patients with bronchiectasis, by histochemical and immunochemical staining. SETTING: 800-bed tertiary university hospital. METHODS: Observational study. PATIENTS: forty-six patients with bronchiectasis in a stable clinical condition and 8 control patients. INTERVENTIONS: Serum samples determination of IgG levels for H. pylori by ELISA. Immunostaining with an anti-H. pylori antibody (NCL-HPp, Novocastra) of bronchial mucosa obtained by fiberoptic bronchoscopy from both patients with bronchiectasis and controls. RESULTS: Twenty-one out of 46 patients with bronchiectasis (46%) had positive serology for H. pylori. We obtained 40 bronchial biopsies in patients with bronchiectasis and 8 bronchial biopsies in control patients. No evidence of H. pylori was obtained in the bronchial samples of both patients and controls. CONCLUSIONS: The results of our study could not demonstrate the presence of H. pylori in bronchial specimens from patients with bronchiectasis.