Displaying publications 1 - 20 of 168 in total

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  1. Ramlee MH, Ammarullah MI, Mohd Sukri NS, Faidzul Hassan NS, Baharuddin MH, Abdul Kadir MR
    Sci Rep, 2024 Mar 21;14(1):6842.
    PMID: 38514731 DOI: 10.1038/s41598-024-57454-8
    Previous research has primarily focused on pre-processing parameters such as design, material selection, and printing techniques to improve the strength of 3D-printed prosthetic leg sockets. However, these methods fail to address the major challenges that arise post-printing, namely failures at the distal end of the socket and susceptibility to shear failure. Addressing this gap, the study aims to enhance the mechanical properties of 3D-printed prosthetic leg sockets through post-processing techniques. Fifteen PLA + prosthetic leg sockets are fabricated and reinforced with four materials: carbon fiber, carbon-Kevlar fiber, fiberglass, and cement. Mechanical and microstructural properties of the sockets are evaluated through axial compression testing and scanning electron microscopy (SEM). Results highlight superior attributes of cement-reinforced sockets, exhibiting significantly higher yield strength (up to 89.57% more than counterparts) and higher Young's modulus (up to 76.15% greater). SEM reveals correlations between microstructural properties and socket strength. These findings deepen the comprehension of 3D-printed prosthetic leg socket post-processing, presenting optimization prospects. Future research can focus on refining fabrication techniques, exploring alternative reinforcement materials, and investigating the long-term durability and functionality of post-processed 3D-printed prosthetic leg sockets.
    Matched MeSH terms: Prosthesis Design
  2. Keun Seon J, Anwar Ayob K, Giun Noh M, Yeol Yang H
    Acta Orthop Traumatol Turc, 2024 Jan;58(1):68-72.
    PMID: 38525513 DOI: 10.5152/j.aott.2024.23115
    Oxidized zirconium (OxiniumTM) prostheses, made up of a metallic alloy of zirconium with a ceramic surface formed by oxidizing the outer layer, were developed as an alternative bearing surface to reduce polyethylene wear and decrease failure of total knee arthroplasty (TKA). We report a unique catastrophic failure of an Oxinium TKA with consequent accelerated wear and severe metallosis. Intraoperatively, we observed extensive wear grooving of the femoral component with exposure of the underlying silver layers and the complete wear of polyethylene on the medial side. Metallic debris had a peculiar arthrogram appearance, noted within the cut surface of the femur and tibia, indicative of the osteolysis that occurred, leading up to the failure of the implants. The histopathologic examination revealed a collection of macrophages with foreign-body reactions and black-pigmented metal-induced wear particles. Oxinium has clear benefits regarding superior wear properties; however, surgeons need to be aware that there is a risk of exposure to the underlying layers that may precede accelerated wear, deformation, and metallosis. Uncovering the deeper layers could result in the appearance of an arthrogram on plain radiographs. Early identification of polyethylene wear and prompt revision is crucial to avoid the rapid progression of subsequent metallosis and catastrophic implant failure, specifically when using oxidized zirconium components for TKA. To the best of our knowledge, this is the first report presenting a detailed histologic analysis to provide insight into the mechanisms of the failed Oxinium components.
    Matched MeSH terms: Prosthesis Design
  3. Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, et al.
    J Mater Chem B, 2023 Nov 15;11(44):10507-10537.
    PMID: 37873807 DOI: 10.1039/d3tb01469j
    The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
    Matched MeSH terms: Prosthesis Design
  4. Patil PG, Lim HF
    J Prosthet Dent, 2023 Jul;130(1):14-18.
    PMID: 34774303 DOI: 10.1016/j.prosdent.2021.08.005
    Fabricating a new crown to retrofit with an existing removable partial denture (RPD) is a complex procedure for both clinician and dental laboratory technician. The presented technique facilitates the fabrication and retrofitting of a metal-ceramic crown onto the principal abutment of the existing RPD by using 2-step intraoral scanning (with and without the RPD in place) and 2 different 3-dimensionally printed casts. The technique enables the dental laboratory technician to precisely reproduce the retentive areas, guiding planes, and rest seats on the retrofitted crown.
    Matched MeSH terms: Dental Prosthesis Design
  5. Nik Zainuddin NAM, Abd Razak NA, Ab Karim MS
    Proc Inst Mech Eng H, 2023 Jun;237(6):741-748.
    PMID: 37131337 DOI: 10.1177/09544119231171787
    Composite materials used in the prosthetic and orthotic fields have helped improve the fabrication of sockets. Laminated sockets proved to be stronger than conventional thermoplastic sockets. The internal surface of a laminated socket plays an important role in patient comfort and is influenced by the material used to fabricate the socket. This study analyzes the internal surface profile of five different materials, that is, Dacron felt, fiberglass, Perlon stockinette, polyester stockinette, and elastic stockinette. All sockets were fabricated using an acrylic resin mix with hardener powder at a ratio of 100:3. The internal surface of the sockets was tested using the Mitutoyo SurfTest SJ-210 series for 20 trials. The overall Ra values were 2.318, 2.380, 2.682, 2.722, and 3.750 µm for fiberglass, polyester, Perlon, elastic stockinette, and Dacron felt. Dacron felt yielded the lowest Ra value, thus, producing the smoothest internal surface but requiring high skill and the correct technique during the fabrication of a laminated socket. Fiberglass is considered the best material for the internal surface despite not producing the lowest value individually but overall is the lowest and most consistent, indicating that it is easy to use to laminate prosthetic sockets.
    Matched MeSH terms: Prosthesis Design
  6. Raj JJ, Thompson M, Whitehouse SL, Jaiprakash A, Varughese I, Crawford RW
    Proc Inst Mech Eng H, 2023 Mar;237(3):368-374.
    PMID: 36734414 DOI: 10.1177/09544119231152351
    Standard practice for acetabular component placement in total hip arthroplasty (THA) is to medialise the acetabular component. Bone preservation techniques during primary THA are beneficial for possible future revisions. The goal of this study is to examine the effect of downsizing and minimising medialisation of the acetabular component on bone resection volume. The volume of bone resected during acetabular preparation for different sizes of components was calculated and the volume of bone preserved by downsizing the cup was determined. Minimising medialisation of the acetabular component by 1-3 mm from the true floor was calculated. Absolute values and percentage of bone volume preserved when acetabular components are downsized or less medialised is presented. Downsizing the acetabular component by one size (2 mm) preserves between 2.6 cm3 (size 40 vs 42) and 8.4 cm3 (size 72 vs 74) of bone volume and consistently reduces resected bone volume by at least 35% (range 35.2%-37.5%). Similarly, reducing medialisation of a 56 mm acetabular cup (as an example of a commonly implanted component) by 3 mm reduces bone loss by 5.9 cm3- 44% less bone volume resection. Downsizing and minimising medialisation of the cup in THA substantially preserves bone which may benefit future revision surgeries. Surgeons could consider implanting the smallest acceptable acetabular shell to preserve bone without compromising on head size.
    Matched MeSH terms: Prosthesis Design
  7. Kaur K
    BMJ Case Rep, 2023 Feb 14;16(2).
    PMID: 36787931 DOI: 10.1136/bcr-2022-251154
    Long-term prognosis of complicated traumatic injuries depends on precise treatment planning. Establishing a balance between a patient's age, prognosis, financial hurdles, and treatment needs is challenging. This case highlights the need for meticulous and realistic treatment planning to achieve long-term favourable outcomes in traumatic injuries in young adults.A young child sustained a traumatic injury that caused avulsion of #21 and intrusion along with palatal luxation of #11. The child reported to the dental clinic with intraoral swelling and pain a week after the injury. Socket preservation was done so that uniform bone contour could be achieved for implant placement at a later stage. We modified a 'Hollywood appliance' as an interim prosthesis to ensure that the ridge was not immediately loaded where socket preservation was done.After a follow-up of 3 years, there is significant bone deposition and the child is satisfied with aesthetics.
    Matched MeSH terms: Prosthesis Design
  8. Abdul Wahab AH, Mohamad Azmi NA, Abdul Kadir MR, Md Saad AP
    Int J Artif Organs, 2022 Feb;45(2):200-206.
    PMID: 33645338 DOI: 10.1177/0391398821999391
    Glenoid conformity is one of the important aspects that could contribute to implant stability. However, the optimal conformity is still being debated among the researchers. Therefore, this study aims to analyze the stress distribution of the implant and cement in three types of conformity (conform, non-conform, and hybrid) in three load conditions (central, anterior, and posterior). Glenoid implant and cement were reconstructed using Solidwork software and a 3D model of scapula bone was done using MIMICS software. Constant load, 750 N, was applied at the central, anterior, and posterior region of the glenoid implant which represents average load for daily living activities for elder people, including, walking with a stick and standing up from a chair. The results showed that, during center load, an implant with dual conformity (hybrid) showed the best (Max Stress-3.93 MPa) and well-distributed stress as compared to other conformity (Non-conform-7.21 MPa, Conform-9.38 MPa). While, during eccentric load (anterior and posterior), high stress was located at the anterior and posterior region with respect to the load applied. Cement stress for non-conform and hybrid implant recorded less than 5 MPa, which indicates it had a very low risk to have cement microcracks, whilst, conform implant was exposed to microcrack of the cement. In conclusion, hybrid conformity showed a promising result that could compromise between conform and non-conform implant. However, further enhancement is required for hybrid implants when dealing with eccentric load (anterior and posterior).
    Matched MeSH terms: Prosthesis Design
  9. Afiqah Hamzah N, Razak NAA, Sayuti Ab Karim M, Gholizadeh H
    Proc Inst Mech Eng H, 2021 Dec;235(12):1359-1374.
    PMID: 34304625 DOI: 10.1177/09544119211035200
    The development of the CAD/CAM (Computer-aided design and computer-aided manufacturing) system has globally changed the fabrication and delivery of prosthetics and orthotics. Furthermore, since the introduction of CAD/CAM in the 1980s, many successful CAD/CAM system are available in the market today. However, less than 20% of amputees have access to digital fabrication technology and large portion of the amputees are from the developing countries. This review designed to examine selected studies from 1980 to 2019 on CAD/CAM systems in the production of transtibial prosthetic sockets. A review was conducted based on articles gathered from Web of Science, Pubmed and Science Direct. From the findings, 92 articles found related to CAD/CAM-derived transtibial prosthetic socket (TPS). After a further screening of the articles, 20 studies were chosen and only one study was done in a developing country. The results showed an increase interest in CAD/CAM application in Transtibial prosthetic socket (TPS) production for both developed and developing countries, yet the technology has not fully utilised in the developing countries. Factors such as resources, accessibility, knowledge-gap and lack of experienced prosthetists remain the major causes of the lack of CAD/CAM system studies. Large-scale trials are required to employ digital fabrication in the developing regions, consequently advancing the production of high-quality CAD-CAM-derived TPS where most prosthetic and orthotics are needed.
    Matched MeSH terms: Prosthesis Design
  10. Hassan LA, Goo CL
    Dent Mater J, 2021 Sep 30;40(5):1189-1195.
    PMID: 34078778 DOI: 10.4012/dmj.2020-408
    This research aimed to evaluate the effect of cement space on the marginal discrepancy and retention of computer-aided design/computer-aided manufacturing (CAD/CAM) crowns. A total of 30 premolar Frasaco teeth were machined to receive crowns with cement spaces of 70, 90, and 110 μm. The marginal discrepancy measurements were done before and after cementation. Pull-off test was conducted using universal testing machine (UTM). Data was analyzed using two-way mixed ANOVA with post-hoc Bonferroni test and Kruskal-Wallis test. The crowns with cement space of 70 μm showed a significantly higher absolute marginal discrepancy than those with 90 and 110 μm. No significant effect on the crown retention was found. Within the limitations of this study, modifying cement space to 90 μm and 110 μm may improve the marginal adaptation of CAD/CAM crown, whereas adjusting cement space from 70 to 110 μm did not significantly affect the crown retention.
    Matched MeSH terms: Dental Prosthesis Design*
  11. Farook TH, Barman A, Abdullah JY, Jamayet NB
    J Prosthodont, 2021 Jun;30(5):420-429.
    PMID: 33200429 DOI: 10.1111/jopr.13286
    PURPOSE: Mesh optimization reduces the texture quality of 3D models in order to reduce storage file size and computational load on a personal computer. This study aims to explore mesh optimization using open source (free) software in the context of prosthodontic application.

    MATERIALS AND METHODS: An auricular prosthesis, a complete denture, and anterior and posterior crowns were constructed using conventional methods and laser scanned to create computerized 3D meshes. The meshes were optimized independently by four computer-aided design software (Meshmixer, Meshlab, Blender, and SculptGL) to 100%, 90%, 75%, 50%, and 25% levels of original file size. Upon optimization, the following parameters were virtually evaluated and compared; mesh vertices, file size, mesh surface area (SA), mesh volume (V), interpoint discrepancies (geometric similarity based on virtual point overlapping), and spatial similarity (volumetric similarity based on shape overlapping). The influence of software and optimization on surface area and volume of each prosthesis was evaluated independently using multiple linear regression.

    RESULTS: There were clear observable differences in vertices, file size, surface area, and volume. The choice of software significantly influenced the overall virtual parameters of auricular prosthesis [SA: F(4,15) = 12.93, R2 = 0.67, p < 0.001. V: F(4,15) = 9.33, R2 = 0.64, p < 0.001] and complete denture [SA: F(4,15) = 10.81, R2 = 0.67, p < 0.001. V: F(4,15) = 3.50, R2 = 0.34, p = 0.030] across optimization levels. Interpoint discrepancies were however limited to <0.1mm and volumetric similarity was >97%.

    CONCLUSION: Open-source mesh optimization of smaller dental prostheses in this study produced minimal loss of geometric and volumetric details. SculptGL models were most influenced by the amount of optimization performed.

    Matched MeSH terms: Dental Prosthesis Design
  12. Chandrasekhar J, Kerkmeijer LS, Kalkman DN, Sartori S, Aquino MB, Woudstra P, et al.
    Catheter Cardiovasc Interv, 2021 04 01;97(5):797-804.
    PMID: 32198837 DOI: 10.1002/ccd.28853
    BACKGROUND: The COMBO drug eluting stent is a novel device with luminal endothelial progenitor cell capture technology for rapid homogeneous endothelialization.

    METHODS AND RESULTS: We examined for sex differences in 1-year outcomes after COMBO stenting from the COMBO collaboration, a pooled patient-level dataset from the MASCOT and REMEDEE multicenter registries. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, target vessel-myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR). Secondary outcomes included stent thrombosis (ST). Adjusted outcomes were assessed using Cox regression methods. The study included 861 (23.8%) women and 2,753 (76.2%) men. Women were older with higher prevalence of several comorbidities including diabetes mellitus. Risk of 1-year TLF was similar in both sexes (3.8% vs. 3.9%, HR 0.92, 95% CI 0.59-1.42, p = .70), without sex differences in the incidence of cardiac death (1.6% vs. 1.5%, p = .78), TV-MI (1.5% vs. 1.1%, p = .32), or CD-TLR (2.0% vs. 2.2%, p = .67). Definite or probable ST occurred in 0.4% women and 1.0% men (HR 0.26, 95% CI 0.06-1.11, p = .069).

    CONCLUSIONS: Despite greater clinical risks at baseline, women treated with COMBO stents had similarly low 1-year TLF and other ischemic outcomes compared to men.

    Matched MeSH terms: Prosthesis Design
  13. Chandrasekhar J, Zeebregts D, Kalkman DN, Sartori S, Roumeliotis A, Aquino MB, et al.
    Cardiovasc Revasc Med, 2020 12;21(12):1542-1547.
    PMID: 32507695 DOI: 10.1016/j.carrev.2020.05.002
    BACKGROUND: Small vessel diameter is associated with higher risk of target lesion revascularization (TLR) after percutaneous coronary intervention (PCI). The COMBO sirolimus-eluting biodegradable-polymer stent has a proprietary anti-CD34 antibody layer to enhance homogeneous endothelialization, which may be advantageous in treating small vessels.

    OBJECTIVE: We examined for differences in 1-year clinical outcomes after PCI by maximum implanted stent diameter from the COMBO collaboration.

    METHODS: The COMBO collaboration (n = 3614) is a patient-level pooled dataset of patients undergoing PCI with COMBO stents in the MASCOT and REMEDEE multicenter registries. Stent diameter was available in 3590 (99.3%) patients. We compared patients receiving COMBO stents <3 mm versus ≥3 mm. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, target vessel-myocardial infarction (TV-MI) or clinically driven TLR. Secondary outcomes included stent thrombosis (ST). Adjusted outcomes were assessed using Cox regression methods.

    RESULTS: The study included 792 (22%) patients with small stents <3 mm and 2798 (78%) patients with large stents ≥3 mm. Small stent patients included more women with lower body mass index and higher prevalence of diabetes but similar prevalence of acute coronary syndrome. Risk of 1-year TLF was similar in small and large stent groups (4.4% vs. 3.8%, HR 1.12, 95% CI 0.74-1.72, p = 0.58). There were no differences in the rates of cardiac death (1.7% vs. 1.5%, p = 0.74), TV-MI (1.4% vs. 1.2%, p = 0.58) or TLR (2.7% vs. 2.1%, p = 0.31). Definite or probable ST occurred in 1.3% of the small stent and 0.7% of the large stent PCI patients, p = 0.14, HR 2.13, 95% CI 0.93-5.00, p = 0.07.

    CONCLUSIONS: One-year ischemic outcomes after COMBO PCI were similar irrespective of stent diameter in this all-comers international cohort.

    Matched MeSH terms: Prosthesis Design
  14. Kamath SU, Agarwal S, Austine J
    Malays Orthop J, 2020 Nov;14(3):143-150.
    PMID: 33403075 DOI: 10.5704/MOJ.2011.022
    Introduction: With a higher proportion of young individuals undergoing uncemented hip arthroplasty, a close match in the dimension of the proximal femur and the implanted prosthesis is paramount. This is a study to gain insight into geographical variation in proximal femur morphology to determine the reference values to design uncemented femoral stems for a south Indian population, and also the effect of ageing and gender on the proximal femur morphology.

    Materials and Methods: The study comprised of two groups. For the first group, 50 unpaired dry femur bones were obtained from adult human cadavers; and the second group was a clinical group of 50 adult patients. Standardised radiographic techniques were used to measure the extra-cortical and intra-cortical morphometric parameters. Based on these, dimensionless ratios were calculated to express the shape of the proximal femur. The data were expressed in terms of mean and standard deviation and a comparison made with other studies.

    Results: A significant difference was noted across various population subsets within the Indian subcontinent and also in comparison to the Western population, suggestive of regional variation. The measurements made in cadaveric bone differed significantly from those in live patients, especially the femoral head diameter and extra-cortical and intra-cortical width. Femoral offset, head height and diameter were significantly less in females.

    Conclusion: The south Indian population needs customised implants with an increase in neck shaft angle and a decrease in intra-cortical and extra-cortical width for press fit in hip arthroplasty. The variation between the two sexes must also be accounted for during prosthesis design.

    Matched MeSH terms: Prosthesis Design
  15. Promphan W, Han Siang K, Prachasilchai P, Jarutach J, Makonkawkeyoon K, Siwaprapakorn W, et al.
    Catheter Cardiovasc Interv, 2020 09 01;96(3):E310-E316.
    PMID: 32299151 DOI: 10.1002/ccd.28892
    OBJECTIVES: To assess feasibility and early outcomes of using BeGraft Aortic stent in the treatment of aortic coarctation (CoA).

    BACKGROUND: BeGraft Aortic stent (Bentley InnoMed, Hechingen, Germany) allows large postdilation diameter up to 30 mm. With availability of lengths of 19-59 mm and lower stent profile, they can be used in native and recurrent CoA in adults and in pediatric patients.

    MATERIALS AND METHODS: This is a multicentre retrospective analysis of 12 implanted BeGraft Aortic stents in CoA between May 2017 and April 2019.

    RESULTS: Twelve patients aged 7.7-38 years (median 18.3 years) with body weight of 19.9-56 kg (median 45.5 kg). Eight patients (66%) had native juxtaductal CoA while four had recurrent CoA after previous surgical or transcatheter treatments. The stents were implanted successfully in all the patients with no serious adverse events. The length of the stents ranged from 27 to 59 mm and the implanted stent diameter varied from 12 to 18 mm. The median intraprocedural CoA pressure gradient decreased from 25 mmHg (range 16-66 mmHg) to 2 mmHg (range 0-13 mmHg). The mean follow-up duration was 10.2 months. Two patient (16.6%) had residual stent narrowing requiring staged redilation. One patient (8%) had pseudoaneurysm formation at 1 year cardiac CT follow-up.

    CONCLUSIONS: The BeGraft Aortic stent may be considered to be safe and effective in the short term in treatment of CoA from childhood to adulthood. Long-term follow-up is needed.

    Matched MeSH terms: Prosthesis Design
  16. Mehboob H, Tarlochan F, Mehboob A, Chang SH, Ramesh S, Harun WSW, et al.
    J Mater Sci Mater Med, 2020 Aug 20;31(9):78.
    PMID: 32816091 DOI: 10.1007/s10856-020-06420-7
    The current study is proposing a design envelope for porous Ti-6Al-4V alloy femoral stems to survive under fatigue loads. Numerical computational analysis of these stems with a body-centered-cube (BCC) structure is conducted in ABAQUS. Femoral stems without shell and with various outer dense shell thicknesses (0.5, 1.0, 1.5, and 2 mm) and inner cores (porosities of 90, 77, 63, 47, 30, and 18%) are analyzed. A design space (envelope) is derived by using stem stiffnesses close to that of the femur bone, maximum fatigue stresses of 0.3σys in the porous part, and endurance limits of the dense part of the stems. The Soderberg approach is successfully employed to compute the factor of safety Nf > 1.1. Fully porous stems without dense shells are concluded to fail under fatigue load. It is thus safe to use the porous stems with a shell thickness of 1.5 and 2 mm for all porosities (18-90%), 1 mm shell with 18 and 30% porosities, and 0.5 mm shell with 18% porosity. The reduction in stress shielding was achieved by 28%. Porous stems incorporated BCC structures with dense shells and beads were successfully printed.
    Matched MeSH terms: Prosthesis Design
  17. Chandrasekhar J, Sartori S, Aquino MB, Baber U, Hájek P, Atzev B, et al.
    Am J Cardiol, 2020 07 15;127:1-8.
    PMID: 32418717 DOI: 10.1016/j.amjcard.2020.04.014
    Older patients who undergo coronary interventions are at greater risk of ischemic events and less likely to tolerate prolonged dual antiplatelet therapy (DAPT) due to bleeding risk. The COMBO biodegradable polymer sirolimus-eluting stent promotes rapid endothelialization through endothelial progenitor cell capture technology which may be advantageous in elderly patients. We compared 1-year clinical outcomes and DAPT cessation events in patients >75 versus ≤75 years from the MASCOT registry. MASCOT was a prospective, multicenter cohort study of all-comers undergoing attempted COMBO stenting. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, myocardial infarction (MI) not clearly attributed to a nontarget vessel or clinically driven target lesion revascularization. Bleeding was adjudicated using the Bleeding Academic Research Consortium criteria. Adjusted outcomes were analyzed using Cox regression methods. The study included 18% (n = 479) patients >75 years and 72% (n = 2,135) patients ≤75 years. One-year TLF occurred in 4.6% patients >75 years versus 3.1% patients ≤75years of age, p = 0.10; adj hazard ratio 1.36, 95% confidence intervals 0.77 to 2.38, p = 0.29. There were no significant differences in cardiac death (1.7% vs 1.3%, p = 0.55), MI (2.1% vs 1.2%, p = 0.14), target lesion revascularization (1.7% vs 1.4%, p = 0.60) and definite stent thrombosis (0.8% vs 0.4%, p = 0.19). Major Bleeding Academic Research Consortium 3,5 bleeding (3.1% vs 1.5%, p = 0.01) and DAPT cessation rates (32.4% vs 23.0%, p <0.001) were significantly higher in elderly patients. In conclusion, elderly patients >75 years treated with COMBO stents had similar TLF but significantly greater incidence of bleeding than younger patients and DAPT cessation in one-third of patients over 1 year.
    Matched MeSH terms: Prosthesis Design
  18. Farook TH, Jamayet NB, Abdullah JY, Rajion ZA, Alam MK
    J Stomatol Oral Maxillofac Surg, 2020 Jun;121(3):268-277.
    PMID: 31610244 DOI: 10.1016/j.jormas.2019.10.003
    A systematic review was conducted in early 2019 to evaluate the articles published that dealt with digital workflow, CAD, rapid prototyping and digital image processing in the rehabilitation by maxillofacial prosthetics. The objective of the review was to primarily identify the recorded cases of orofacial rehabilitation made by maxillofacial prosthetics using computer assisted 3D printing. Secondary objectives were to analyze the methods of data acquisition recorded with challenges and limitations documented with various software in the workflow. Articles were searched from Scopus, PubMed and Google Scholar based on the predetermined eligibility criteria. Thirty-nine selected papers from 1992 to 2019 were then read and categorized according to type of prosthesis described in the papers. For nasal prostheses, Common Methods of data acquisition mentioned were computed tomography, photogrammetry and laser scanners. After image processing, computer aided design (CAD) was used to design and merge the prosthesis to the peripheral healthy tissue. Designing and printing the mold was more preferred. Moisture and muscle movement affected the overall fit especially for prostheses directly designed and printed. For auricular prostheses, laser scanning was most preferred. For unilateral defects, CAD was used to mirror the healthy tissue over to the defect side. Authors emphasized on the need of digital library for prostheses selection, especially for bilateral defects. Printing the mold and conventionally creating the prosthesis was most preferred due to issues of proper fit and color matching. Orbital prostheses follow a similar workflow as auricular prosthesis. 3D photogrammetry and laser scans were more preferred and directly printing the prosthesis was favored in various instance. However, ocular prostheses fabrication was recorded to be a challenge due to difficulties in appropriate volume reconstruction and inability to mirror healthy globe. Only successful cases of digitally designed and printed iris were noted.
    Matched MeSH terms: Prosthesis Design
  19. Velayudhan BV, Idhrees M, Matalanis G, Park KH, Tang D, Sfeir PM, et al.
    J Cardiovasc Surg (Torino), 2020 Jun;61(3):285-291.
    PMID: 32337940 DOI: 10.23736/S0021-9509.20.11397-1
    Acute type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field, the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy. Few surgeons argue for a conservative approach to reduce operative and postoperative morbidity while others considering the problems associated with "downstream problems" support an aggressive approach including a frozen elephant trunk. The cohort in the Indian subcontinent and APAC is far different from the western world. Many factors determine the decision for surgery apart from the pathology of the disease. Economy, availability of the suitable prosthesis, the experience of the surgeon, ease of access to the medical facility all contribute to the decision making to treat acute type A dissection.
    Matched MeSH terms: Prosthesis Design
  20. Krackhardt F, Waliszewski M, Kočka V, Toušek P, Janek B, Hudec M, et al.
    Cardiovasc Drugs Ther, 2020 06;34(3):335-344.
    PMID: 32212061 DOI: 10.1007/s10557-020-06963-5
    OBJECTIVES: The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population.

    METHODS: Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel.

    RESULTS: For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age

    Matched MeSH terms: Prosthesis Design
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