Contact angle, protein adsorption and osteoblast precursor cell attachment to chitosan coatings bonded to titanium.

Chitosan, a derivative of the bio-polysaccharide chitin, has shown promise as a bioactive material for implant, tissue engineering and drug-delivery applications. The aim of this study was to evaluate the contact angle, protein adsorption and osteoblast precursor cell attachment to chitosan coatings bonded to titanium. Rough ground titanium (Ti) coupons were solution cast and bonded to 91.2% de-acetylated chitosan (1 wt% chitosan in 0.2% acetic acid) coatings via silane reactions. Non-coated Ti was used as controls. Samples were sterilized by ethylene oxide gas prior to experiments. Contact angles on all surfaces were measured using water. 5 x 10(4) cells/ml of ATCC CRL 1486 human embryonic palatal mesenchyme (HEPM) cells, an osteoblast precursor cell line, were used for the cell attachment study. SEM evaluations were performed on cells attached to all surfaces. Contact angles and cell attachment on all surfaces were statistically analyzed using ANOVA. The chitosan-coated surfaces (76.4 +/- 5.1 degrees) exhibited a significantly greater contact angle compared to control Ti surfaces (32.2 +/- 6.1 degrees). Similarly, chitosan-coated surfaces exhibited significantly greater (P < 0.001) albumin adsorption, fibronectin adsorption and cell attachment, as compared to the control Ti surfaces. Coating chitosan on Ti surfaces decreased the wettability of the Ti, but increased protein adsorption and cell attachment. Increased protein absorption and cell attachment on the chitosan-coated Ti may be of benefit in enhancing osseointegration of implant devices.

Relation between intracranial pressure, computed tomographic lesion, and neuropsychological outcome.

Long-term neuropsychological recovery of 24 severe head-injured patients was examined and correlated with acute measurements of intracranial pressure (ICP) and diffuse computed tomographic (CT) lesions. Intracranial hypertension (ICP greater than or equal to 20 mm Hg) was present acutely in 12 patients and absent in 12 patients. CT diagnoses of diffuse swelling (DS) was present in 12 patients, and diffuse axonal injury (DAI) in 12 patients. During chronic recovery, neuropsychological dysfunctioning was found in all cases. Patients with acute ICP elevations showed more intellectual and memory losses than those without acute ICP elevations. No neuropsychological differences were found between patients with DS and DAI injuries. The findings suggest secondary brain insults caused by intracranial hypertension may be more disruptive to long-term neuropsychological functioning than diffuse lesion type.

The shaken baby syndrome. A clinical, pathological, and biomechanical study.

Because a history of shaking is often lacking in the so-called "shaken baby syndrome," diagnosis is usually based on a constellation of clinical and radiographic findings. Forty-eight cases of infants and young children with this diagnosis seen between 1978 and 1985 at the Children's Hospital of Philadelphia were reviewed. All patients had a presenting history thought to be suspicious for child abuse, and either retinal hemorrhages with subdural or subarachnoid hemorrhages or a computerized tomography scan showing subdural or subarachnoid hemorrhages with interhemispheric blood. The physical examination and presence of associated trauma were analyzed; autopsy findings for the 13 fatalities were reviewed. All fatal cases had signs of blunt impact to the head, although in more than half of them these findings were noted only at autopsy. All deaths were associated with uncontrollably increased intracranial pressure. Models of 1-month-old infants with various neck and skull parameters were instrumented with accelerometers and shaken and impacted against padded or unpadded surfaces. Angular accelerations for shakes were smaller than those for impacts by a factor of 50. All shakes fell below injury thresholds established for subhuman primates scaled for the same brain mass, while impacts spanned concussion, subdural hematoma, and diffuse axonal injury ranges. It was concluded that severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome.

Influence of lesions detected by computed tomography on outcome and neuropsychological recovery after severe head injury.

Outcome at 6 months after severe head injury was determined in 117 patients whose computed tomographic (CT) examinations demonstrated diffuse axonal injury (DAI), diffuse swelling (DS), or focal injuries. Neuropsychological sequelae were ascertained from two examinations in 30 of the conscious survivors within the 1st year after injury. Outcome differences varied with the type of CT lesion. DS and focal injuries resulted in more favorable (good recovery) outcomes. Mortality was higher after DAI. Neuropsychological outcome varied with the type of CT lesion and the function measured. Overall differences in memory and learning were revealed among the three CT lesion categories, whereas differences in intelligence and visuomotor functions were not significant. Levels of memory, learning, and visuomotor speed were higher after DS injuries, but improvement was less. Greater improvement of memory, learning, and visuomotor speed occurred after DAI. After focal injuries, visuomotor speed improved, but not recall and learning. The results suggest that the type of injury incurred differentially influences the outcome and the neuropsychological aftermath of severely head-injured adults.

Relation of visual field defects to neuropsychological outcome after closed head injury.

Neuropsychological outcome within two years after injury was determined in 159 head injured patients who were classified into three groups according to the presence of either unilateral, bilateral, or no visual field defects (VFDs). The VFDs occurred irrespective of injury severity as determined by the Glasgow coma scale, or social outcome as determined by the Glasgow outcome scale. Differences among the three visual field groups were obtained for several neuropsychological functions: intelligence, memory, learning, acquired verbal skills, visuospatial skills, and visuomotor speed. Patients with bilateral VFDs were more severely impaired neuropsychologically than those with unilateral or no VFDs. Occurrences of secondary complications (brain swelling, intracranial hypertension, and hyperemia) were more prevalent among the bilateral VFD cases. The findings suggested that bilateral VFDs may be indicators of increased brain damage from secondary insults.