A Tooth Decaying in the Appendix: An Unusual Cause of Appendicitis.

Appendicitis is a very common indication for surgery, although in recent years uncomplicated cases have often been managed with antibiotics. In this case, we discuss a patient who presented to the emergency department with a case of seemingly uncomplicated acute appendicitis. Physical exam, history, and imaging indicated that this was due to an ingested foreign body, specifically a dental crown, that had impacted the appendix. In cases of ingested foreign bodies, antibiotics are not an appropriate treatment for appendicitis and all cases should be treated surgically if the patient will tolerate surgery. A thorough history and physical exam, as well as imaging when indicated, can assist in the assessment of such patients.

U.S. military implantable collamer lens surgical outcomes: 11-year retrospective review.

PURPOSE: To examine the long-term efficacy and safety of myopic implantable collamer lens (ICL) implantation in active duty personnel of U.S. military. SETTING: Hospital practice. DESIGN: Retrospective longitudinal observational study. METHODS: 1485 patients (median age 25, interquartile range 22 to 29) underwent ICL surgery. Patients received a preoperative examination including uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), manifest refraction measuring corrected distance visual acuity (CDVA), corneal topography and tomography, qualitative grading of perceived ectatic risk, ophthalmic biometry, and baseline endothelial cell counts (ECCs). Outcome measures included UDVA, IOP, vault size, manifest refraction, CDVA, and ECCs. The long-term follow-up data ware drawn from the U.S. military medical record system. RESULTS: A total of 3105 eyes were evaluated. Patients received ICLs because of either abnormal topography (2111 eyes [68%]) or high myopia (994 eyes [32%]). 94 eyes (80%) maintained UDVA of 20/25 or better up to 8 years postoperatively. The rate of achieving the desired refractive correction was 97% (503 eyes) at 1 year and 90% (81 eyes) at 8 years. Stability of these outcomes was also shown by minimal change in manifest refraction. Documented mean ECC loss was 22% at postoperative year 5. The overall rate of adverse events was 1.2% (36 eyes) including visually significant cataract formation, glaucoma, retinal detachment, and traumatic incision opening. A removal or replacement rate of 4.5% (135 eyes) was observed. CONCLUSIONS: ICL implantation was found to be effective and safe. Vault sizes decreased over time, suggesting an increased risk of cataract formation after 7 years. Further study is necessary to assess long-term clinical significance of ECC decline.

A Parameter Study for 3D-Printing Organized Nanofibrous Collagen Scaffolds Using Direct-Write Electrospinning.

Collagen-based scaffolds are gaining more prominence in the field of tissue engineering. However, readily available collagen scaffolds either lack the rigid structure (hydrogels) and/or the organization (biopapers) seen in many organ tissues, such as the cornea and meniscus. Direct-write electrospinning is a promising potential additive manufacturing technique for constructing highly ordered fibrous scaffolds for tissue engineering and foundational studies in cellular behavior, but requires specific process parameters (voltage, relative humidity, solvent) in order to produce organized structures depending on the polymer chosen. To date, no work has been done to optimize direct-write electrospinning parameters for use with pure collagen. In this work, a custom electrospinning 3D printer was constructed to derive optimal direct write electrospinning parameters (voltage, relative humidity and acetic acid concentrations) for pure collagen. A LabVIEW program was built to automate control of the print stage. Relative humidity and electrospinning current were monitored in real-time to determine the impact on fiber morphology. Fiber orientation was analyzed via a newly defined parameter (spin quality ratio (SQR)). Finally, tensile tests were performed on electrospun fibrous mats as a proof of concept.