Influence of Different Sterilization Methods on the Surface Chemistry and Electrochemical Behavior of Biomedical Alloys.

Sterilization is a prerequisite for biomedical devices before contacting the human body. It guarantees the lack of infection by eliminating microorganisms (i.e., bacteria, spores and fungi). It constitutes the last fabrication process of a biomedical device. The aim of this paper is to understand the effect of different sterilization methods (ethanol-EtOH, autoclave-AC, autoclave + ultraviolet radiation-ACUV and gamma irradiation-G) on the surface chemistry and electrochemical reactivity (with special attention on the kinetics of the oxygen reduction reaction) of CoCrMo and titanium biomedical alloys used as prosthetic materials. To do that, electrochemical measurements (open circuit potential, polarization resistance, cathodic potentiodynamic polarization and electrochemical impedance spectroscopy) and surface analyses (Auger Electron Spectroscopy) of the sterilized surfaces were carried out. The obtained results show that the effect of sterilization on the corrosion behavior of biomedical alloys is material-dependent: for CoCrMo alloys, autoclave treatment increases the thickness and the chromium content of the passive film increasing its corrosion resistance compared to simple sterilization in EtOH, while in titanium and its alloys, autoclave and UV-light accelerates its corrosion rate by accelerating the kinetics of oxygen reduction.

A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy.

BACKGROUND: Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. METHODS: Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. RESULTS: A total of 246 pulmonary resections with LND for clinical stages I-II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. CONCLUSIONS: In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.

The Influence of Preoperative Nutritional and Systemic Inflammatory Status on Perioperative Outcomes following Da Vinci Robot-Assisted Thoracic Lung Cancer Surgery.

Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperative complications (p = 0.569), mean hospital stay (p = 0.258) or duration of chest drain (p = 0.369). Higher inflammatory status, with an NLR > 1.84, was associated with more overall postoperative complications (p = 0.028), only in univariate analysis, but this significance was not maintained on multivariate analysis. Conclusions: BMI was not a predictor of increased postoperative risk in this cohort; therefore, weight should not deter surgeons from using RATS for pulmonary resection.

Preoperative Omega-6/Omega-3 Fatty Acid Ratio Could Predict Postoperative Outcomes in Patients with Surgically Resected Non-Small-Cell Lung Cancer.

Introduction: The aim of this study was to determine whether preoperative nutritional status and inflammatory status, specifically polyunsaturated acids and the omega 6/3 ratio, would affect postoperative outcomes and complications in patients with lung cancer undergoing lung resection. Methods: This prospective observational study included 68 patients with early-stage non-small-cell lung cancer who were candidates for radical surgery. A complete nutritional assessment was performed. The primary study variable was postoperative complications and mortality in the first 30 days. Descriptive, bivariate, and logistic regression analyses were carried out. Results: A total of 50 men (73.53%) and 18 women (26.47%) underwent surgery, with a median age of 64.2 (±9.74) years. The mean omega 6/3 ratio was 17.39 (±9.45). A complication occurred in 39.7% of the study sample (n = 27), the most common being persistent air leak in 23.53% (n = 16). After performing the bivariate analysis, the only variable that remained significant was the omega 6/3 ratio; we observed that it had a prognostic value for persistent air leak (p = 0.001) independent of age, sex, comorbidity, preoperative respiratory function, and approach or type of surgery. The remaining nutritional and inflammatory markers did not have a statistically significant association (p > 0.05) with postoperative complications. However, this significance was not maintained in the multivariate analysis by a small margin (p = 0.052; 95% CI: 0.77-1.41). Conclusions: Omega 6/3 ratio may be a prognostic factor for air leak, independent of the patient's clinical and pathological characteristics.

The Electrochemical Behavior of Ti in Human Synovial Fluids.

In this study, we report results of the interaction of titanium (Ti) with human synovial fluids. A wide palette of electrochemical techniques was used, including open circuit potential, potentiodynamic methods, and electrochemical impedance. After the electrochemical testing, selected surfaces were analyzed using Auger Electron Spectroscopy to provide laterally resolved information on surface chemistry. For comparison purposes, similar tests were conducted in a series of simulated body fluids. This study shows that compared to the tested simulated body fluids, synovial liquids show a large patient variability up to one order of magnitude for some crucial electrochemical parameters such as corrosion current density. The electrochemical behavior of Ti exposed to human synovial fluids seems to be controlled by the interaction with organic molecules rather than with reactive oxygen species.

Adsorption of organic matter on titanium surfaces with nano- and micro-scale roughness studied with the electrochemical quartz crystal microbalance dissipation technique.

Adsorption of calf serum organic matter from a phosphate-buffered solution was studied using the electrochemical quartz crystal microbalance with additional dissipation measurements. Two types of crystal surfaces were used: one rough with micrometer-range surface features and one with roughness in the low nanometer range. The results showed that the adsorption of the organic material was about 1.5 orders of magnitude larger on the rough surface and almost independent of serum concentration in the electrolyte. The adsorption rates were found to increase with increasing serum concentration. For rough crystals, the adsorption kinetics were interpreted with the Johnson-Mehl-Avrami-Kolmogorov model, indicating an initial growth phase according to the tn-law, followed by a slower growth as the nucleation sites fill up. This study suggests that specific surface sites are critical to promote adsorption of proteins on a titanium surface.

Adipokinetic hormone (AKH), energy budget and their effect on feeding and gustatory processes of foraging honey bees.

The adipokinetic hormone (AKH) of insects is considered an equivalent of the mammalian hormone glucagon as it induces fast mobilization of carbohydrates and lipids from the fat body upon starvation. Yet, in foraging honey bees, which lack fat body storage for carbohydrates, it was suggested that AKH may have lost its original function. Here we manipulated the energy budget of bee foragers to determine the effect of AKH on appetitive responses. As AKH participates in a cascade leading to acceptance of unpalatable substances in starved Drosophila, we also assessed its effect on foragers presented with sucrose solution spiked with salicin. Starved and partially-fed bees were topically exposed with different doses of AKH to determine if this hormone modifies food ingestion and sucrose responsiveness. We found a significant effect of the energy budget (i.e. starved vs. partially-fed) on the decision to ingest or respond to both pure sucrose solution and sucrose solution spiked with salicin, but no effect of AKH per se. These results are consistent with a loss of function of AKH in honey bee foragers, in accordance with a social life that implies storing energy resources in the hive, in amounts that exceed individual needs.

A Crevice Corrosion Model for Biomedical Trunnion Geometries and Surfaces Feature.

Modular hip joint implants were introduced in arthroplasty medical procedures because they facilitate the tailoring of patients' anatomy, the use of different materials in one single configuration, as well as medical revision. However, in certain cases, such prostheses may undergo deterioration at the head-neck junctions with negative clinical consequences. Crevice-corrosion is commonly invoked as one of the degradation mechanisms acting at those junctions despite biomedical alloys such as Ti6Al4V and CoCr being considered generally resistant to this form of corrosion. To verify the occurrence of crevice corrosion in modular hip joint junctions, laboratory crevice-corrosion tests were conducted in this work under hip joint-relevant conditions, i.e., using similar convergent crevice geometries, materials (Ti6Al4V and CoCr alloys vs. ceramic), surface finish, NaCl solution pHs (5.6 and 2.3), and electrochemical conditions. A theoretical model was also developed to describe crevice-corrosion considering relevant geometrical and electrochemical parameters. To verify the model, a FeCr alloy, known to be sensitive to this phenomenon, was subjected to the crevice-corrosion test in sulfuric acid. The experiments and the model predictions clearly showed that, in principle, crevice corrosion of Ti6Al4V or CoCr is not supposed to occur in typical crevices formed at the stem-neck junction of hip implants.

An Overview of Serum Albumin Interactions with Biomedical Alloys.

Understanding the interactions between biomedical alloys and body fluids is of importance for the successful and safe performance of implanted devices. Albumin, as the first protein that comes in contact with an implant surface, can determine the biocompatibility of biomedical alloys. The interaction of albumin with biomedical alloys is a complex process influenced by numerous factors. This literature overview aims at presenting the current understanding of the mechanisms of serum albumin (both Bovine Serum Albumin, BSA, and Human Serum Albumin, HSA) interactions with biomedical alloys, considering only those research works that present a mechanistic description of the involved phenomena. Widely used biomedical alloys, such as 316L steel, CoCrMo and Titanium alloys are specifically addressed in this overview. Considering the literature analysis, four albumin-related phenomena can be distinguished: adsorption, reduction, precipitation, and protein-metal binding. The experimental techniques used to understand and quantify those phenomena are described together with the studied parameters influencing them. The crucial effect of the electrochemical potential on those phenomena is highlighted. The effect of the albumin-related phenomena on corrosion behavior of biomedical materials also is discussed.

Relationship Among Radiological Measurements of Anterior Mediastinal Fat and Outcomes of Lung Transplantation in Fibrotic Patients / Relación entre las medidas radiológicas de la grasa mediastínica anterior y los resultados del trasplante de pulmón en pacientes con fibrosis

OBJECTIVE: Lung transplantation (LT) for pulmonary fibrosis is related to higher mortality than other transplant indications. We aim to assess whether the amount of anterior mediastinal fat (AMF) was associated to early and long-term outcomes in fibrotic patients undergoing LT. METHODS: Retrospective analysis of 92 consecutive single lung transplants (SLT) for pulmonary fibrosis over a 10-year period. AMF dimensions were measured on preoperative CT-scan: anteroposterior axis (AP), transverse axis (T), and height (H). AMF volumes (V) were calculated by the formula: AP×T×H×3.14/6. According to the radiological AMF dimensions, patients were distributed into two groups: low-AMF (V < 20 cm3) and high-AMF (V > 20 cm3), and early and long-term outcomes were compared by univariable and multivariable analyses. RESULTS: There were 92 SLT: 73M/19F, 53 ± 11 [14-68] years old. 30-Day mortality (low-AMF vs. high-AMF): 5 (5.4%) vs. 15 (16.3%), p = 0.014. Patients developing primary graft dysfunction within 72 h post-transplant, and those dying within 30 days post-transplant presented higher AMF volumes: 21.1 ± 19.8 vs. 43.3 ± 24.7 cm3 (p = 0.03) and 24.4 ± 24.2 vs. 56.9 ± 63.6 cm3 (p < 0.01) respectively. Overall survival (low-AMF vs. high-AMF) (1, 3, and 5 years): 85%, 81%, 78% vs. 55%, 40%, 33% (p < 0.001). Factors predicting 30-day mortality were: BMI (HR = 0.77, p = 0.011), AMF volume (HR = 1.04, p = 0.018), CPB (HR = 1.42, p = 0.002), ischaemic time (HR = 1.01, p = 0.009). Factors predicting survival were: AMF volume (HR=1.02, p < 0.001), CPB (HR = 3.17, p = 0.003), ischaemic time (HR = 1.01, p = 0.001). CONCLUSION: Preoperative radiological assessment of mediastinal fat dimensions and volumes may be a useful tool to identify fibrotic patients at higher risk of mortality after single lung transplantation

OBJETIVO: El trasplante de pulmón (TP) para el tratamiento de la fibrosis pulmonar está relacionado con una mayor mortalidad que otras indicaciones de trasplante. Nuestro objetivo es evaluar si la cantidad de grasa mediastínica anterior (GMA) se asoció a los diferentes resultados tempranos y a largo plazo en pacientes con fibrosis a los que se les realizó un TP. MÉTODOS: Análisis retrospectivo de 92 trasplantes de pulmón unilaterales (TPU) consecutivos para el tratamiento de la fibrosis pulmonar durante un período de 10 años. Se midieron las dimensiones de la GMA en la TC preoperatoria: eje anteroposterior (AP), eje transversal (T) y altura (A). Los volúmenes de GMA (V) se calcularon mediante la fórmula: AP×T×A×3,14/6. Según las dimensiones radiológicas de la GMA, los pacientes se distribuyeron en 2 grupos: GMA baja (V < 20 cm3) y GMA alta (V > 20 cm3), y los resultados tempranos y a largo plazo se compararon mediante análisis univariables y multivariables. RESULTADOS: Se realizaron 92 TPU: 73V/19M, 53 ± 11 (14-68) años. Mortalidad a 30 días (GMA baja frente a GMA alta): 5 (5,4%) frente a 15 (16,3%); p = 0,014. Los pacientes que desarrollaron disfunción precoz del injerto dentro de las 72 h posteriores al trasplante, y los que murieron dentro de los 30 días posteriores al trasplante presentaron mayores volúmenes de GMA: 21,1±19,8 frente a 43,3 ± 24,7 cm3 (p = 0,03) y 24,4 ± 24,2 frente a 56,9 ± 63,6 cm3 (p < 0,01), respectivamente. Supervivencia global (GMA baja frente a GMA alta) (a los 1, 3 y 5 años): 85, 81 y 78% frente al 55, 40 y 33% (p < 0,001), respectivamente. Los factores que predijeron la mortalidad a los 30 días fueron: IMC (HR = 0,77; p = 0,011), volumen de la GMA (HR = 1,04; p = 0,018), CEC (HR = 1,42; p = 0,002), tiempo de isquemia (HR=1,01; p = 0,009). Los factores que predijeron la supervivencia fueron: volumen GMA (HR = 1,02; p < 0,001), CEC (HR = 3,17; p = 0,003) y tiempo de isquemia (HR = 1,01; p = 0,001)

Relationship Among Radiological Measurements of Anterior Mediastinal Fat and Outcomes of Lung Transplantation in Fibrotic Patients.

OBJECTIVE: Lung transplantation (LT) for pulmonary fibrosis is related to higher mortality than other transplant indications. We aim to assess whether the amount of anterior mediastinal fat (AMF) was associated to early and long-term outcomes in fibrotic patients undergoing LT. METHODS: Retrospective analysis of 92 consecutive single lung transplants (SLT) for pulmonary fibrosis over a 10-year period. AMF dimensions were measured on preoperative CT-scan: anteroposterior axis (AP), transverse axis (T), and height (H). AMF volumes (V) were calculated by the formula: AP×T×H×3.14/6. According to the radiological AMF dimensions, patients were distributed into two groups: low-AMF (V<20cm3) and high-AMF (V>20cm3), and early and long-term outcomes were compared by univariable and multivariable analyses. RESULTS: There were 92 SLT: 73M/19F, 53±11 [14-68] years old. 30-Day mortality (low-AMF vs. high-AMF): 5 (5.4%) vs. 15 (16.3%), p=0.014. Patients developing primary graft dysfunction within 72h post-transplant, and those dying within 30 days post-transplant presented higher AMF volumes: 21.1±19.8 vs. 43.3±24.7cm3 (p=0.03) and 24.4±24.2 vs. 56.9±63.6cm3 (p<0.01) respectively. Overall survival (low-AMF vs. high-AMF) (1, 3, and 5 years): 85%, 81%, 78% vs. 55%, 40%, 33% (p<0.001). Factors predicting 30-day mortality were: BMI (HR=0.77, p=0.011), AMF volume (HR=1.04, p=0.018), CPB (HR=1.42, p=0.002), ischaemic time (HR=1.01, p=0.009). Factors predicting survival were: AMF volume (HR=1.02, p<0.001), CPB (HR=3.17, p=0.003), ischaemic time (HR=1.01, p=0.001). CONCLUSION: Preoperative radiological assessment of mediastinal fat dimensions and volumes may be a useful tool to identify fibrotic patients at higher risk of mortality after single lung transplantation.

Tribocorrosion behaviour of pure titanium in bovine serum albumin solution: A multiscale study.

Tribocorrosion behaviour of pure titanium in phosphate buffer saline (PBS) solution has been investigated systematically as a function of surface chemistry and bovine serum albumin (BSA) content in the solution. A ball-on-disk tribometer coupled with an electrochemical cell was used to study the effect of electrochemical conditions (i.e. anodic and cathodic applied potentials, as well as at open circuit potential) on the tribocorrosion response of titanium. It was found that the main material loss is due to mechanical wear caused by plastic deformation. The mechanical wear was higher under anodic conditions than under cathodic, partially due to an increased presence of debris particles at the sliding interface that act as third bodies. The effect of BSA on the interaction between alumina and titanium, as well as the behaviour of third bodies during the mechanical wear, were investigated in the nanoscale level using atomic force microscopy based force spectroscopy. It was found that the presence of BSA affects tribocorrosion in various ways. Firstly, it increases the repassivation rate of the oxide film by inhibiting the cathodic reactions and accelerating the anodic reactions. Secondly, it increases the mechanical wear by increasing the adhesion of debris onto the sliding interface, while at anodic conditions it increases the rolling efficiency of the debris particles that further enhances the mechanical wear.

Dissection, Culture and Analysis of Primary Cranial Neural Crest Cells from Mouse for the Study of Neural Crest Cell Delamination and Migration.

Over the past several decades there has been an increased availability of genetically modified mouse models used to mimic human pathologies. However, the ability to study cell movements and differentiation in vivo is still very difficult. Neurocristopathies, or disorders of the neural crest lineage, are particularly challenging to study due to a lack of accessibility of key embryonic stages and the difficulties in separating out the neural crest mesenchyme from adjacent mesodermal mesenchyme. Here, we set out to establish a well-defined, routine protocol for the culture of primary cranial neural crest cells. In our approach we dissect out the mouse neural plate border during the initial neural crest induction stage. The neural plate border region is explanted and cultured. The neural crest cells form in an epithelial sheet surrounding the neural plate border, and by 24 h after explant, begin to delaminate, undergoing an epithelial-mesenchymal transition (EMT) to become fully motile neural crest cells. Due to our two-dimensional culturing approach, the distinct tissue populations (neural plate versus premigratory and migratory neural crest) can be readily distinguished. Using live imaging approaches, we can then identify changes in neural crest induction, EMT and migratory behaviors. The combination of this technique with genetic mutants will be a very powerful approach for understanding normal and pathological neural crest cell biology.

Effect of the electrochemical characteristics of titanium on the adsorption kinetics of albumin.

An electrochemical quartz crystal microbalance (EQCM) was used to examine the electrochemical behaviour of pure titanium in phosphate buffered saline (PBS) and PBS-containing bovine serum albumin (BSA) solutions, and the associated adsorption characteristics of BSA under cathodic and anodic applied potentials. It was found that the electrochemical behaviours of bulk titanium substrate and titanium-coated QCM sensors are slightly different in PBS buffer solution, which is attributed to the difference in their surface roughness. The oxide film formed on the surface of the QCM sensor during potentiostatic tests was found to affect its electrochemical behaviour, while cathodic cleaning is not sufficient to have it removed. Lastly, the excessive amount of electrons on the titanium surface upon application of a cathodic potential could result in the desorption of BSA due to electrostatic repulsion and protein dehydration. In contrast, application of anodic potential charges the titanium surface positively and can facilitate protein adsorption when the surface is not saturated with protein.

The impacts of morning, daytime, and nighttime symptoms on disease burden in real-world patients with COPD.

Background: Respiratory symptoms are increasingly recognized as an important consideration in COPD management. Understanding the links between the time(s) of day symptoms are experienced and overall symptom burden could support personalized management strategies. This real-world study aimed to establish the association between the time of day of symptoms and the burden on patients using validated patient-reported outcomes, health care resource utilization, and physician-perceived impact of COPD on patients' lives. Materials and methods: Analyses used data from four waves (2012, 2013, 2014, and 2016) of the Respiratory Disease Specific Programme: cross-sectional surveys of patients with COPD in Germany, Italy, Spain, and the UK. Patients were classified by their physicians as having symptoms in the morning (M), daytime (D), and/or nighttime (N) in the 4 weeks before entering the Disease Specific Programme. Outcomes included health care resource utilization, work productivity and activity impairment, COPD Assessment Test, EuroQol 5-dimension 3-level questionnaire with visual analog scale, and Jenkins Sleep Evaluation Questionnaire. Results: In total, 8,844 patients were included, and 8,185 had evaluable time-of-day symptom data. Physicians reported that in the previous 4 weeks, 25% of patients experienced no symptoms, 16% D only, 17% M/D only, 6% D/N only, 4% M, N, or M/N only, and 32% M/D/N. In general, patients with M/D/N symptoms utilized more health care resources in the previous 12 months, had more prior exacerbations, and reported worse activity impairment, health status, and sleep than other symptom groups, whereas patients with symptoms at any time of the day utilized more resources, experienced more exacerbations, and reported worse health status than patients with no symptoms during the 4 weeks before entering the survey. Conclusion: Patients experiencing morning, daytime, and nighttime symptoms experience a greater disease burden than those in other groups. An individualized approach to COPD treatment based on the timing and persistence of symptoms may improve outcomes for these patients.

Glycogen synthase kinase 3 controls migration of the neural crest lineage in mouse and Xenopus.

Neural crest migration is critical to its physiological function. Mechanisms controlling mammalian neural crest migration are comparatively unknown, due to difficulties accessing this cell population in vivo. Here we report requirements of glycogen synthase kinase 3 (GSK3) in regulating the neural crest in Xenopus and mouse models. We demonstrate that GSK3 is tyrosine phosphorylated (pY) in mouse neural crest cells and that loss of GSK3 leads to increased pFAK and misregulation of Rac1 and lamellipodin, key regulators of cell migration. Genetic reduction of GSK3 results in failure of migration. We find that pY-GSK3 phosphorylation depends on anaplastic lymphoma kinase (ALK), a protein associated with neuroblastoma. Consistent with this, neuroblastoma cells with increased ALK activity express high levels of pY-GSK3, and blockade of GSK3 or ALK can affect migration of these cells. Altogether, this work identifies a role for GSK3 in cell migration during neural crest development and cancer.

Electrochemical Behaviour and Galvanic Effects of Titanium Implants Coupled to Metallic Suprastructures in Artificial Saliva.

The aim of the present study is to analyze the electrochemical behavior of five different dental alloys: two cobalt-chromium alloys (CoCr and CoCr-c), one nickel-chromium-titanium alloy (NiCrTi), one gold-palladium alloy (Au), and one titanium alloy (Ti6Al4V), and the galvanic effect when they are coupled to titanium implants (TiG2). It was carried out by electrochemical techniques (open circuit measurements, potentiodynamic curves and Zero-Resistance Ammetry) in artificial saliva (AS), with and without fluorides in different acidic conditions. The studied alloys are spontaneously passivated, but NiCrTi alloy has a very narrow passive domain and losses its passivity in presence of fluorides, so is not considered as a good option for implant superstructures. Variations of pH from 6.5 to 3 in artificial saliva do not change the electrochemical behavior of Ti, Ti6Al4V, and CoCr alloys, and couples, but when the pH of the artificial saliva is below 3.5 and the fluoride content is 1000 ppm Ti and Ti6Al4V starts actively dissolving, and CoCr-c superstructures coupled to Ti show acceleration of corrosion due to galvanic effects. Thus, NiCrTi is not recommended for implant superstructures because of risk of Ni ion release to the body, and fluorides should be avoided in acidic media because Ti, Ti6Al4V, and CoCr-c superstructures show galvanic corrosion. The best combinations are Ti/Ti6Al4V and Ti/CoCr as alternative of noble gold alloys.

Reduction in clinically important deterioration in chronic obstructive pulmonary disease with aclidinium/formoterol.

BACKGROUND: 'Clinically important deterioration' (CID) is a composite endpoint measuring worsening of the key clinical features of chronic obstructive pulmonary disease (COPD), namely lung function, patient-reported outcomes, and exacerbations. ACLIFORM and AUGMENT were two 24-week, randomized, double-blind, phase III studies assessing twice-daily (BID) aclidinium bromide (AB) 400 µg/formoterol fumarate (FF) 12 µg. This pooled post-hoc analysis assessed the effects of AB/FF 400/12 µg on both first and sustained CID events versus placebo and monotherapies in patients with moderate to severe COPD. METHODS: A first CID event was defined as the occurrence of a moderate/severe exacerbation or the worsening from baseline in ≥1 of the following: trough forced expiratory volume in 1 second (FEV1; ≥100 mL), Transition Dyspnea Index (TDI) focal score (≥1 unit), or St George's Respiratory Questionnaire (SGRQ) total score (≥4 units). A 'sustained' CID was defined as a worsening maintained at all subsequent visits from appearance to week 24 or a moderate/severe exacerbation at any time. CID events were assessed at three visits (weeks 4, 12, and 24); trough FEV1 was also measured at weeks 1 and 18. RESULTS: AB/FF 400/12 µg reduced the risk of a first CID event by 45% versus placebo (hazard ratio [HR] 0.55, p < 0.001), 18% versus FF 12 µg (HR 0.82, p < 0.01), and 15% versus AB 400 µg (HR 0.85, p < 0.05). Similarly, AB/FF 400/12 µg reduced the risk of a sustained CID event by 48% versus placebo (HR 0.52, p < 0.001) and 22% versus FF 12 µg (HR 0.78, p < 0.01). AB/FF 400/12 µg reduced the risk of a first or sustained CID event for all four components versus placebo (trough FEV1 and TDI, first and sustained CID, all p < 0.001; SGRQ first CID p < 0.001; SGRQ sustained CID, p < 0.01; exacerbations first and sustained CID, both p < 0.05) and TDI and SGRQ versus FF 12 µg (TDI, first and sustained CID both p < 0.05; SGRQ first CID p < 0.01), and SGRQ versus AB 400 µg (first CID, p < 0.05). CONCLUSIONS: AB/FF 400/12 µg BID may provide greater airway stability and fewer exacerbations or deteriorations in lung function, health status, or dyspnea compared with placebo or monotherapies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01462942 (ACLIFORM); registered 26 October 2011. Clinicaltrials.gov NCT01437397 (AUGMENT); registered 19 September 2011.

Degradation mechanisms and future challenges of titanium and its alloys for dental implant applications in oral environment.

OBJECTIVE: For many decades the failure of titanium implants due to corrosion and wear were approached individually and their synergic effect was not considered. In recent past, developments and understanding of the tribocorrosion aspects have thrown deeper understanding on the failure of implants and this has been reviewed in this article extensively. METHODS: Medline, google scholar and Embase search was conducted to identify studies published between 1993 and 2016 which were related to the analysis of degradation mechanism which the dental implants undergo after implantation. RESULTS: In-vitro tests has been extensively carried out to evaluate the tribocorrosion behavior of titanium based dental implants. However, there is still a lack of knowledge about the tangible behavior of materials under in-vivo condition, because the in-vitro experiments are conducted using different testing protocols and conditions (solutions, pH, time, equipment, and testing parameters). Hence, there is an urgent need to perform round-robin test in different laboratories which will help to overcome the gap between in-vitro and in-vivo conditions. CONCLUSION: Tribocorrosion has been identified as the major degradation mechanisms that result in the failure of dental implants. Hence, it is of utmost importance to improve the service period of dental implants by reducing the tribocorrosion effects through developing new dental implant materials using nobler alloying elements or through modifying the surface of the implants. In order to have a thorough understanding of tribocorrosion behavior and failure mechanisms, round robin test are to be conducted and new protocols/standards are to be developed for the testing of implants.