Journal of foot and ankle researchKade L Paterson, Kim L Bennell, Adam Bryant, Peixuan Li, Anurika P De Silva, Sam Shearer, Rana S Hinman
INTRODUCTION: First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and disabling condition that causes substantial pain and impairs quality of life. Cushioned insoles have the potential to lower plantar pressures beneath the hallux and possibly reduce pain, but their clinical effectiveness has not been investigated. This study describes the protocol for a randomised controlled trial (RCT) assessing whether daily use of cushioned insoles produces greater reductions in first MTP joint walking pain, and other symptoms, over 12 weeks than sham insoles. METHODS AND ANALYSIS: This two-arm, parallel group, superiority RCT will recruit 108 community-dwelling adults aged 45 years and older with symptomatic radiographic first MTP joint OA. Participants will be randomised to receive three pairs of either cushioned insoles (6 mm low-density ethyl vinyl acetate (EVA)) or visually similar thin sham insoles (2 mm high-density EVA), to be worn for 12 weeks. The primary outcome is the 12-week change in first MTP joint pain during walking, assessed using an 11-point numerical rating scale (0-10, higher scores worse pain). Secondary outcomes include 12-week changes in physical function, other measures of first MTP joint pain, health-related quality of life, physical activity, and fear of movement. Global ratings of change in pain and function will also be assessed at 12 weeks. Other measures will also be collected. Analyses will include all participants as randomised using linear and log-binomial regression adjusted for baseline values. Prespecified sensitivity and moderator analyses will also be conducted. ETHICS AND DISSEMINATION: This study has been approved by the University of Melbourne Greater than Low Risk Human Research Ethics Committee. Findings will provide the first evidence regarding the efficacy of cushioned insoles for the management of first metatarsophalangeal joint OA. Results will be disseminated via peer-reviewed journals, scientific conferences, information on our website and lay summaries for participants. TRIAL REGISTRATION: Prospectively registered on the 14 of December 2023 with the Australian New Zealand Clinical Trials Registry, reference ACTRN12623001304628.
Journal of foot and ankle researchMichael A Hunt, Natasha M Krowchuk, Haocheng Zhang, Michael B Ryan, Trevor B Birmingham, Jesse M Charlton
BACKGROUND: Lateral wedge insoles (LWIs) are a non-surgical adjunct treatment for knee osteoarthritis (OA) that has been shown to reduce the knee adduction moment-a biomechanical risk factor for knee OA disease progression. Though worn in one's shoes, little is known of the effects of LWIs use on the foot or ankle. Importantly, it unknown whether their use enhances foot symptoms in people with knee OA and concomitant foot pain, thus questioning the general appropriateness of their use in this subgroup. METHODS: We conducted a pilot, feasibility randomized controlled trial to assess study approaches and general effects of LWIs use in people with knee OA and foot pain. 30 individuals with foot pain and radiographically-confirmed knee OA were randomized to a 12-week intervention using either standalone 6-degree LWIs or LWIs integrated with custom foot and arch support. Feasibility outcomes included: recruitment and retention outcomes; insoles usage, reporting, and comfort; and adverse events. We also examined foot (Foot Function Index pain and difficulty subscales) and knee symptoms (Knee Osteoarthritis Outcomes Severity Score pain and daily function subscales), and gait biomechanics (knee adduction and flexion moment peaks and impulses, ankle/subtalar eversion peaks) before and after the 12-week intervention. RESULTS: All feasibility criteria were met, and no major adverse events were reported. Participants found the insoles moderately comfortable (7/10), and most weeks (278/336, 83%) met the acceptable 30 min per day wear time threshold. Though no statistical comparisons were made, changes in clinical and biomechanical outcomes were consistent with previous research; specifically, trends toward improvement in knee pain and function, as well as knee adduction moment magnitudes, in both groups. CONCLUSION: Lateral wedge insoles, with or without support, appear safe for people with knee OA and concomitant foot pain. Given positive feasibility and efficacy observations, future research in this area is warranted.
Clinical implant dentistry and related researchHadar Better, Thabet Asbi, Keren Better, Elazar Librush, Liat Barness-Hadar, Gavriel Chaushu, Doron Haim
AIM: To evaluate survival rates and identify temporally distinct risk factors for early and late failure of wide-diameter dental implants (≥ 5.0 mm) in a large real-world cohort using landmark analysis. MATERIALS AND METHODS: This retrospective cohort study analyzed 12 041 wide-diameter implants (≥ 5.0 mm), predominantly 5.0 mm, placed in 9247 patients at a single center between January 2014 and December 2023. Implant survival was defined as the fixture remaining in situ without clinical loss or replacement at the same site. Failures were classified as early (≤ 1 year) or late (> 1 year). Kaplan-Meier survival curves and a multivariable Cox proportional hazards model clustered by patient were generated. Schoenfeld residuals revealed time-varying effects for penicillin allergy, implant length, and kidney disease, prompting a landmark analysis at 365 days with separate multivariable logistic regression models for early and late failure. RESULTS: Overall implant survival was 97.5%. Kaplan-Meier estimates were 98.1% (95% CI: 97.9%-98.4%) at 1 year, 97.8% (95% CI: 97.5%-98.0%) at 3 years, and 97.6% (95% CI: 97.4%-97.9%) at 5 years. Of 301 failures, 225 (74.8%) were early and 76 (25.2%) were late. In the Cox model, short implants (≤ 8 mm; HR = 1.94, 95% CI: 1.43-2.62, p < 0.001), maxillary placement (HR = 2.13 vs. mandible, p < 0.001), male sex (HR = 1.39, p = 0.010), penicillin allergy (HR = 1.66, p = 0.014), and older age (HR = 0.84 per SD, p = 0.008) independently predicted failure; smoking was borderline (HR = 1.33, p = 0.065). Landmark analysis showed that early failure was driven by penicillin allergy (OR = 2.26, p < 0.001), maxillary placement (OR = 2.42, p < 0.001), male sex (OR = 1.40, p = 0.016), and short length (OR = 1.70, p = 0.007), whereas late failure was driven by short length (OR = 3.19, p < 0.001) and kidney disease (OR = 6.11, p = 0.003). CONCLUSIONS: Wide-diameter implants achieve excellent long-term survival. Early and late failures arise from distinct mechanisms: perioperative, anatomical, and sex-related factors predominate early, while short implant length and renal disease predominate late. These findings support tailored perioperative protocols, individualized risk stratification, and targeted long-term surveillance.
Journal of orthopaedic traumaMichele N Cerasani, Gloria Zhang, Sanjit Konda, Abhishek Ganta
This review details an open reduction internal fixation technique of a comminuted, intraarticular Y-type bicolumnar distal humerus fracture using supplemental minifragment plating in addition to dual locking plates. Owing to significant articular comminution, an olecranon osteotomy with an anconeus pedicle flap was used to facilitate exposure to achieve an accurate articular reduction to restore elbow function.
Clinical and experimental dental researchOttavia Cannatella, Biagio Matera, Francesca Rossi, Giovanni Passeri, Simone Lumetti, Ludovica Parisi, Benedetta Ghezzi
OBJECTIVE: Immune cells are the first to interact with implant surfaces, yet their contribution to osseointegration is often underestimated. Understanding how titanium-based and zirconia-enriched surface properties regulate macrophage polarization is essential for designing regenerative biomaterials. This study evaluates how these physicochemical characteristics modulate macrophage behavior and how macrophage-derived signals affect osteoblast mineralization, a key determinant of successful clinical outcomes. MATERIAL AND METHODS: Human monocytes were differentiated into pro-inflammatory (M1) or anti-inflammatory (M2) macrophages on hydrophobic and hydrophilic titanium (P, SLA/modSLA) or zirconia-enriched titanium (R/modR) surfaces. Macrophage polarization was assessed by Real Time-PCR, fluorescent immunoassays, and Luminex analysis of pro-/anti-inflammatory cytokines and bone-related markers. Conditioned media from M1/M2 macrophages cultured on each surface were used to culture human osteoblast-like cells, and their differentiation and mineralization were evaluated by gene expression analysis and Alizarin Red staining. RESULTS: The obtained results indicate that surface chemical composition, rather than hydrophilicity, is the main driver of early macrophage phenotype modulation. Zirconia incorporation induced effects comparable to titanium on macrophage activation while increasing transcription of pro- and anti-inflammatory genes. Moreover, zirconia enhanced M1 activation and the release of angiogenic and osteogenic mediators, including VEGF and OPN. Although seemingly contradictory, these effects contribute to an immune microenvironment favorable to bone formation by promoting a balanced macrophage response. Consistently, zirconia-enriched surfaces enhanced osteoblastic differentiation and mineralization, regardless of hydrophilic differences compared with conventional titanium surfaces. CONCLUSION: Our findings indicate that zirconia-supplemented titanium alloys may provide a useful model to elucidate the concept of osseointegration as an osteoimmune process rather than a conventional bone healing response. The data emphasize the critical role of early M1 macrophage activity controlling the release of specific cytokines, supporting the hypothesis that the use of titanium/zirconia alloys may provide an osteoiummunomodulatory advantage that may contrast peri-implant bone loss.
Journal of orthopaedic traumaTheodor Di Pauli von Treuheim, Michele N Cerasani, Sanjit Konda, Abhishek Ganta
This abstract describes an open reduction and internal fixation technique used for a supination adduction ankle injury. This technique demonstrates medial plafond articular disimpaction with backfilling of the bony void with cancellous allograft. The medial malleolus was then fixed with a mini fragment plate in antiglide fashion with subchondral rafting screws. The lateral malleolus fracture was addressed with use of a retrograde screw rather than a fibular plate. This technique emphasizes the importance of both recognizing and addressing the anteromedial plafond impaction of supination adduction ankle fractures.
Journal of orthopaedic traumaSamara Moll, Jonah Dewing, Gabriel Bouz, Jacques Hacquebord, Omri Ayalon
Transradial amputation of appropriate length preserves forearm rotation and facilitates prosthetic use; however, high rates of phantom limb pain and neuropathic medication use persist. This case describes a multidisciplinary approach to transradial amputation that integrates targeted muscle reinnervation, regenerative peripheral nerve interfaces, and bone and soft tissue management to optimize pain control and prosthetic success. A 29-year-old man with a severe ballistic injury and complex regional pain syndrome underwent transradial amputation with targeted muscle reinnervation and regenerative peripheral nerve interface. Limb length was preserved in accordance with prosthetic guidelines, and myodesis was performed to improve residual limb stability and myoelectric signal quality. This case highlights how nerve management and prosthetic-informed surgical planning optimizes functional outcomes and quality of life after traumatic transradial amputation.
Computer assisted surgery (Abingdon, England)Qingzhuo Chi, Guofeng Wang, Wenjun Wang, Xijing Zhuang, Yuanzhe Jin, Bo Liu, Ying He
Fabricating high-fidelity, patient-specific aortic phantoms that possess both complex pathological features and physiological compliance remains a significant challenge for single-method manufacturing techniques. This study presents a complete virtual-to-physical prototyping workflow, enabled by a novel Hybrid Additive Manufacturing Platform (HAMP), for translating clinical imaging data into high-fidelity, patient-specific aortic phantoms. Building upon a validated brush-spin-coating technique capable of precise wall thickness control (±0.1 mm), the HAMP synergistically integrates 3D printing and casting. This integration overcomes the limitations of single-method techniques, uniquely enabling the creation of phantoms with (i) controllable interlayer delamination for mimicking dissection, (ii) enclosed multi-chamber structures for endoleak simulation, (iii) seamless integration of dissimilar materials, and (iv) the replication of complex intra-wall pathologies such as intramural hematoma. The platform's capability was rigorously demonstrated through the successful fabrication and application of four distinct classes of aortic phantoms. These high-fidelity models were directly employed in: fundamental biomechanical studies to visualize dissection propagation; advanced surgical training for complex procedures like ex vivo fenestration; emergency preoperative planning, where a patient-specific model was delivered in under 30 h; and industrial medical device testing using parametric, ISO-compliant models. In each scenario, the phantoms provided functional, anatomically accurate representations suitable for the intended evaluation-whether physical testing, surgical rehearsal, or hydrodynamic assessment. In summary, the HAMP demonstrates a rapid virtual-to-physical prototyping workflow. By enabling the on-demand creation of complex, multi-material, patient-specific phantoms, it provides a versatile tool that bridges digital data and physical reality, addressing needs across research, clinical training, and device development.
Complementary therapies in medicineErda Qorri, Jasemin Todri, Orges Lena
BACKGROUND: Low back pain (LBP) is prevalent among rhythmic gymnastics athletes due to repetitive spinal loading and postural asymmetries. The Mézières Method, a postural re-education approach, aims to restore global muscle balance, while occlusal splints (oral bytes) have been proposed to optimize posture and neuromuscular control. This study investigated the combined and independent effects of postural therapy and oral byte use on pain, function, flexibility, and quality of life in elite rhythmic gymnasts with LBP. METHODS: Eighty-nine gymnasts were screened, and 39 met inclusion criteria and completed the intervention: 20 with oral byte and 19 without. All participants underwent the Mézières Method program for six months, consisting of two weekly sessions (30 min each) supervised by a certified physiotherapist. Outcomes included pain intensity (VAS-Pain), functional disability (Roland-Morris Disability Questionnaire-RMDQ), Short Form-12 Health Survey (SF-12), with the Physical Component Summary (PCS) and the Mental Component Summary (MCS), and flexibility (Sit-and-Reach test). Data were analyzed using multivariate ANCOVA and linear mixed-effects models with baseline values as covariates. RESULTS: Both groups demonstrated significant improvements over time in VAS and RMDQ; p < 0.001, with no significant between-group or interaction effects, indicating comparable improvements. PCS and MCS scores improved significantly over time (p < 0.01), indicating enhanced health-related quality of life. Flexibility increased in both groups (p < 0.001), with moderate-to-large effect sizes (η² = 0.12-0.21). No adverse events were reported. CONCLUSIONS: Six months of Mézières-based postural therapy were associated with significant improvements in pain, function, flexibility, and quality of life in rhythmic gymnasts with low back pain. However, in the absence of a non-intervention control group, these improvements may be partially influenced by non-specific or placebo effects. The addition of an occlusal bite device did not produce consistent additional benefits across outcomes. Further controlled studies are needed to determine the specific efficacy of these interventions. TRIAL REGISTRATION: NCT03849053; Registered on 19 February 2019.
Implantable neural microelectrodes are the core components enabling high spatiotemporal resolution neural signal recording and stimulation in brain-computer interfaces (BCIs). However, current technologies still face challenges in achieving high-throughput recording, precise implantation, and long-term stability. In this work, we present a high-throughput three-dimensional (3D) helical stretchable neural probe, fabricated via planar electrode micro-fabrication technology followed by thermally driven helical shaping. The main innovations are reflected in the following: First, through the helical deformation, it is possible to simultaneously achieve cross-tissue recording on cortical surface, deep brain, and inside blood vessels. Secondly, the helical structure can expand the wiring space of the electrodes into three dimensions, achieving high spatial resolution and good mechanical compatibility with the tissue. Interface mechanics simulations indicate that the helical structure effectively mitigates strain induced by brain micromotion. Electrochemical modification significantly reduces interface impedance and enhances charge storage capacity (CSC), while cyclic stretching tests confirm stable electrochemical performance under repeated high-strain conditions. Trans-tissue in vivo experiments further validate the probe's versatility: flexible planar MEAs successfully recorded high-quality subcutaneous electromyography (EMG) signals in mice; the helical probe captured single-unit activity in the deep brain of mice with long-term recording stability; and 1024-channel high-throughput signal acquisition was achieved in the pig cerebral cortex. This technology enables high-throughput, stretchable, and cross-scale long-term stable neural recording, providing a versatile tool for next-generation BCIs and clinical neuromonitoring.
Renal failureElvan Onur Kırımker, Deniz Kütük, Kıvanç Kılınç, Mehmet Ali Koç, Acar Tüzüner, Akın Fırat Kocaay
BACKGROUND: Urological complications remain a significant source of morbidity following kidney transplantation, often leading to re-intervention and graft dysfunction. Although advances in surgical technique and perioperative care have reduced incidence rates, controversy persists regarding risk predictors and the prophylactic role of double-J ureteral stenting. METHODS: We retrospectively analyzed 425 adult kidney transplant recipients at a single tertiary center between January 2008 and December 2023. Patient demographics, donor characteristics, surgical variables, and postoperative outcomes were reviewed. Complications were defined as urinary leak, ureteral stricture, or anastomotic obstruction requiring intervention within 12 months. Data were compared across three eras (2008-2012, 2013-2017, 2018-2023). Multivariable logistic regression identified independent risk factors. RESULTS: Overall, 11.1% (n = 47) of patients developed urological complications. Ureteral stricture was the most frequent (57%), followed by urinary leak (28%) and anastomotic obstruction (15%). Older recipient age (OR 1.04, 95% CI 1.01-1.07, p = 0.012), re-transplantation (OR 2.95, 95% CI 1.12-7.77, p = 0.028), and deceased donor grafts (OR 2.17, 95% CI 1.12-4.19, p = 0.021) were independent predictors. Prophylactic double-J ureteral stenting demonstrated a non-significant protective trend (OR 0.71, 95% CI 0.44-1.15, p = 0.091). Routine stenting in Era 3 coincided with a non-significant reduction in leak and stricture rates. CONCLUSION: Older age, re-transplantation, and deceased donor grafts independently predicted complications, while prophylactic stenting showed a non-significant protective effect. Further multicenter studies are needed to validate these findings and optimize stent protocols.
European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.VTiandian Wang, Anuj A Biswas, Feng Zhang, Rongjin Sun, Ming Hu
With annual overdose deaths in the United States over 1 million, medication-assisted treatment with buprenorphine (BUP) remains the first-line, gold-standard therapy for opioid use disorder (OUD). Because OUD is a chronic, relapsing condition that requires long-term pharmacotherapy, long acting injectables (LAI) and implantable formulations offer important advantages over daily formulations for maintenance treatment. By comparing transmucosal BUP and LAI formulations' systemic exposure profiles and μ-opioid receptor (MOR) occupancy, converging data demonstrate that higher and more sustained BUP exposure with low variability is required to fully suppress withdrawal, cravings, and illicit opioid use. These findings indicated that currently marketed formulations may not adequately address the clinical challenges associated in the fentanyl/polysubstance era. Accordingly, this rationale-based review proposes a mechanistic framework supporting the development of next-generation BUP-PLGA solid biodegradable implants to maintain a conservative therapeutic benchmark (e.g. Css ≥ 5 ng/mL) for extended durations (e.g. 3-6 months) with low variability (e.g. no large burst release, major lag phase or phase inversion). However, progress in implant development has been hindered by limited mechanistic understanding of drug release. In PLGA-BUP systems, poor IVIVC is largely driven by the low and pH-dependent solubility of BUP, which can make dissolution rate-limiting in vivo and interact with the evolving PLGA acidic microenvironment (acidification, porosity formation, and autocatalytic degradation). Future research should be prioritized to determine directly whether polymer erosion coincides with drug release in PLGA depots, or whether residual, poorly soluble BUP persists locally and releases under dissolution-limited kinetics. Clarifying these mechanisms is not only essential to fulfill the regulatory and translational expectations of the FDA and NIDA, but also to deepen mechanistic understanding and accelerate the rational development of LAI formulations for poorly soluble drug.
Microbial pathogenesisSyed Ali Danish Kazmi, Bushra Jabeen, Noor Ul Huda, Shaista Urooj, Fouzia Zeeshan Khan, Tanveer Abbas, Zulfiqar Ali Mirani
Dental prosthesis failure is often associated with biofilm-mediated infections, yet the combined roles of surface roughness and material chemistry remain underexplored. This observational, retrospective study investigated associations between these factors and biofilm density, pathogen selection, and prosthesis longevity. Surface roughness (Ra) and microbial colonization were analyzed for 85 explanted prostheses (fixed, removable, implant-supported, and orthodontic) and compared to control samples (polished enamel, sealants). Biofilm formation was quantified via optical density (OD) and colony-forming units (CFU/cm2), while pathogen profiles were identified using selective culture and biochemical assays. A strong positive correlation (R2 = 0.84, interpreted as a very strong correlation according to Evans' (1996) classification) was observed between surface roughness and biofilm accumulation. Smooth surfaces like zirconia (Ra ∼320 nm) exhibited low biofilm (OD 0.45), whereas rougher surfaces, particularly removable PMMA dentures (Ra ∼1100 nm), showed dense biofilms (OD up to 1.85) dominated by Candida spp. and Pseudomonas aeruginosa. Material chemistry was associated with distinct pathogen profiles: PMMA favored fungal and Gram-negative adhesion, while titanium promoted staphylococcal colonization. In this cohort, biofilm-associated infections were associated with reduced functional longevity; for example, implant crowns designed for 15+ years were removed after a mean of 5.4 years due to peri-implantitis. The study concludes that prosthetic failure is associated with the synergistic effect of surface topography, which correlates with biofilm quantity, and material composition, which is associated with distinct microbial ecology. These findings underscore the need for prostheses engineered with optimized surface smoothness and antimicrobial material chemistry. However, the observational, retrospective design limits causal inference; the culture-based methodology likely underestimates the full microbial diversity, particularly of anaerobic species; and the heterogeneity of device types limits direct comparability between groups.
Journal of dentistryMarco Ferrari, Ovidiu Ionut Saracutu, Denise Irene Karin Pontoriero, Giorgio Gastaldi, Giulia Verniani, Daniele Manfredini, Edoardo Ferrari Cagidiaco
AIM: To compare the outcome of short fiber reinforced composites, as a core material, with respect to conventional fiber post, for the reconstruction of anterior endodontically treated teeth (ETT), covered by a lithium disilicate crown. MATERIALS AND METHODS: Patients in need of endodontic treatment and a single-unit full crown restoration for anterior teeth (incisors or canines) were recruited. Only teeth with >50% of residual tooth structure were included. The teeth were required to be in occlusal function with a natural antagonist tooth and in interproximal contact with two adjacent natural teeth. A simple randomized design with 2 arms was adopted to evenly allocate patients to the two experimental groups. The fluctuation of oral behaviors was assessed via the Oral Behavior Checklist. For the assessment of the prosthodontic outcome, the modified US Public Health Service criteria were used. Statistical analysis was set at p<0.05. RESULTS: The statistical analysis showed no significant association between the type of build-up material, the high risk for oral behaviors (p = 0.197), and the prosthodontic failures (p = 0.471). CONCLUSION: This randomized clinical trial shows no significant difference in the outcome of anterior ETT with >50% of residual tooth structure restored with fiber post or fiber-reinforced composite, covered by a lithium disilicate crown, at 5 years of follow-up. CLINICAL SIGNIFICANCE: Short fiber-reinforced composites represent a valid alternative material to fiber post, for the build-up of anterior endodontically treated teeth, with at least 50% of residual tooth structure, covered by a lithium disilicate crown.
Journal of dentistryMark-Steven Howe, Derek Richards
OBJECTIVE: Restorative dentistry lacks an integrated prognostic framework linking restorability assessment to long-term survival evidence. This study evaluates whether published 10-year survival data can be systematically anchored to an existing multi-domain restorability index to develop a structured Restorative Dental Prognosis Index (RDPI). METHODS: A theory-driven, five-stage conceptual methodology was applied. A structured literature search identified validated restorability or risk indices as a conceptual anchor. Prognostic features were classified by relevance to restorative outcomes. Published 10-year survival estimates and uncertainty intervals were extracted from systematic reviews and re-analysed to characterise dispersion. Estimates were mapped onto an ordinal prognostic structure to minimise overfitting in heterogeneous evidence. Scenario modelling explored internal coherence, recognising differences between whole-mouth and tooth-level risk. No empirical validation was undertaken. RESULTS: A single multidomain index met eligibility criteria. Across 13 domains, 10-year survival estimates showed wide variation (74-93%), very broad prediction intervals, and high heterogeneity (I²=74.8-99.8%). Despite this, survival data aligned with a three-category ordinal structure, generating a coherent prognostic scaffold. Scenario modelling demonstrated non-linear increases in whole-mouth risk and integration of biological risk with financial exposure. CONCLUSIONS: By mapping long-term survival evidence onto a validated multidomain restorability framework, this proof-of-concept framework provides a structurally consistent prognostic scaffold. While not a predictive model, it offers a foundation for future empirical parameterisation, validation, and integration into restorative treatment planning, teaching, and practice. CLINICAL SIGNIFICANCE: This framework integrates multi-domain restorability assessment with long-term survival evidence to support whole-mouth prognostic reasoning. By simplifying heterogeneous data into ordinal risk states and enabling aggregation, it may help clinicians compare strategies, anticipate failure risk, and align decisions with proportionality, cost exposure, and patient-centred outcomes.
Journal of the mechanical behavior of biomedical materialsAvocet Y Nagle-Christensen, Dylan Heino, Kimberly A Nickerson, William R Ledoux, Scott Telfer, Brittney C Muir
Custom accommodative insoles fabricated from multilayer foams are the standard of care (SoC) for offloading elevated plantar pressures in individuals with diabetes at risk of foot ulceration. While SoC insoles have demonstrated short-term effectiveness, they are prone to permanent material deformation over time, reducing their offloading efficacy. Recent work has shown that 3D-printed multilayer lattice structures using elastomeric polyurethane (EPU) can match the mechanical properties of SoC foams and is effective in reducing plantar pressures. However, their long-term pressure offloading performance and durability have not been investigated. In this pilot study, 3D-printed EPU multilayer lattice pucks and SoC multilayer foam pucks, with and without designed offloading regions, underwent one million cycles of sinusoidal compressive loading under both uniform and uneven loading conditions. Peak pressure (PP), pressure time integral (PTI), residual thickness, and elastic modulus were assessed at multiple timepoints throughout testing. Under uniform loading, both materials maintained stable PPs below the 200 kPa clinical threshold across one million cycles. Under uneven loading, SoC pucks exhibited progressive pressure increases and residual thickness reductions of up to 36%, while 3D-printed pucks maintained structural integrity with thickness reductions of 3% or less and demonstrated reduced PP over time. Both materials with designed offloading regions effectively maintained PPs below 150 kPa throughout testing. These results from bench testing are promising and show the potential for 3D-printed multilayer lattice materials as a durable and effective long-term strategy for pressure reduction.
Journal of the mechanical behavior of biomedical materialsIbrahim T Teke, Ahmet H Ertas
This study presents a geometry-driven optimization framework for additively manufactured implant-like lattice architectures, focusing on the control of architecture-dependent cyclic mechanical response. The proposed Manufacturability-Aware Surrogate-Assisted Topology Optimization framework integrates a genetic algorithm, a Gaussian-process surrogate model, and gradient-based refinement within a unified pipeline that enforces additive manufacturing constraints. The framework uses a deformation-derived mechanical response proxy to guide the ranking of manufacturable lattice architectures according to their expected stiffness-related and dissipation-related behavior. Optimized M-88 and M-2525 architectures were fabricated from PLA and evaluated under quasi-static and cyclic compression. The finer M-2525 architecture exhibited higher quasi-static stiffness and a more storage-dominated cyclic response, whereas the coarser M-88 architecture showed a stronger loss-modulus contribution and more dissipative cyclic behavior. These cyclic trends were consistent with the quasi-static compression results, indicating that geometry-driven design can shift the response of lattice architectures between stiff elastic behavior and more viscous or dissipative behavior. Overall, the proposed framework provides a computational-experimental route for tuning geometry-dependent cyclic response in manufacturable additively manufactured lattices.
Journal of dentistryKay-Arne Walther, Mehmet Ali Akdeniz, Bernd Wöstmann, Jonas Adrian Helmut Vogler
OBJECTIVES: The study aimed to evaluate the long-term correlation between periodontal parameters at implants and contra-lateral natural teeth over a follow-up period of up to 20 years in periodontitis patients undergoing supportive periodontal care (SPC). MATERIALS AND METHODS: This observational cohort study involved systemically healthy, non-smoking patients who received periodontal and implant therapy, followed by regular SPC. The following parameters were assessed at baseline (i.e. implant loading) and at 5, 10, 15 and 20 years: clinical attachment level (CAL), pocket probing depth (PPD), gingival margin (GM) and bleeding on probing (BOP). Intra- and inter-group differences over time between implants and teeth were analysed. Survival rates were calculated. RESULTS: 167 patients with 419 implants were included. Mean CAL increased significantly over time at implants and teeth (p ≤ 0.015), approximately doubling every five years. After 20 years, CAL loss amounted to 4.47±2.45 mm at implants and 4.38±2.64 mm at teeth. Implants demonstrated significantly greater PPD increases after 10 and 15 years compared with teeth (p ≤ 0.027), whereas differences in CAL between implants and teeth were largely non-significant beyond 5 years. Differences in GM and BOP were small and inconsistent. No association was observed between SPC frequency and changes in CAL or PPD. Implant survival was 100% and three contra-lateral teeth were lost over 20 years. CONCLUSIONS: In patients with treated periodontitis under regular SPC, implants and natural teeth exhibited comparable long-term clinical stability and survival. However, a non-linear progression of CAL loss occurs at teeth and implants, which SPC effectively limits but does not completely prevent. CLINICAL SIGNIFICANCE: For systemically healthy, non-smoking patients with treated periodontitis who attend SPC programme twice per year, implants can provide durable tooth replacement. Survival is comparable to that of contra-lateral teeth over 20 years. Clinicians should prioritise maintenance and monitoring, as CAL and PPD may progress despite overall excellent long-term survival.
Journal of the mechanical behavior of biomedical materialsAbdurrahim Temiz, Ahmet Serdar Güldibi, Fatih Huzeyfe Öztürk, İsmail Aykut Karamanlı
This study presents the design and mechanical evaluation of a novel bone-mimicking hierarchical lattice structure. A cylindrical specimen (20 mm diameter × 20 mm height) was partitioned into two concentric regions to emulate the heterogeneity of natural bone: a solid inner core (10 mm diameter) and an outer annular region (10-20 mm). Distinct cylindrical lattice architectures were assigned to each region using nTopology software. To introduce hierarchical complexity, rectangular lattice structures were embedded within the cylindrical lattice walls of the inner region, while the outer annulus maintained a conventional cylindrical lattice morphology. Lattice topologies (G, D, L, and S types) and arc counts (2 and 4) were systematically varied based on a Taguchi design of experiments (DOE), enabling controlled investigation of topology combinations and geometric parameters. All specimens were additively manufactured and tested under uniaxial compression. Mechanical performance was assessed in terms of first peak stress, energy absorption, and specific energy absorption. Deformation behavior and failure mechanisms were qualitatively analyzed in-situ imaging at consistent displacement intervals. Additionally, density-dependent elastic properties were interpreted using the Gibson-Ashby model to establish structure-property relationships. Results indicate that hierarchical dual-zone lattice configurations emulate the mechanical heterogeneity of natural bone, offering highly tunable energy absorption and promoting stable, progressive collapse. The integration of inter-regional topology variation with intra-wall hierarchical design offers an effective approach for tailoring mechanical response and functional performance. These results demonstrate the potential of the proposed framework for tailoring mechanical properties, and surface area characteristics in lattice structures for biomimetic bone scaffolds.
International braz j urol : official journal of the Brazilian Society of UrologyManuela Horta, Thiago A Teixeira, Danilo C Nagato, Carlos V, Gabriel P O Lima, Eduardo Z S Pato, Plinio M Goes, José de Bessa, William C Nahas, Jorge Hallak, B…
PURPOSE: To critically evaluate the clinical presentation, imaging performance and surgical findings of malleable penile prosthesis (MPP) fractures in a high-volume tertiary center. MATERIALS AND METHODS: Medical reports of men who underwent revision surgery with intraoperative confirmation of MPP fracture between January 2008 and January 2025 were reviewed. MPP from a single manufacturer (Promedon®, Cordoba, Argentina) were inserted, and no comparisons were possible. Demographic data, presenting symptoms, imaging findings, and fracture location were analyzed. Diagnostic performance of physical examination and imaging modalities was descriptively compared. RESULTS: Among 741 penile prosthetic procedures, 98 were revisions and 52 (53.1%) were due to MPP fracture. Median time from implantation to fracture was 59 months (IQR 24.8-84.0). Penile instability was the most common symptom (96.1%), while pain was reported in 21.1%. Physical examination correctly identified fractures in 88.5% of cases, outperforming radiography and magnetic resonance imaging. Bilateral fractures occurred in 51.9% of revisions, most commonly in the proximal segment. Recurrent fractures occurred in 28.2% of patients. CONCLUSIONS: MPP fractures are more prevalent than expected and a clinically relevant complication in high-volume centers. Diagnosis relies primarily on clinical assessment, with physical examination outperforming imaging modalities. Increased awareness of typical presentation patterns may support earlier recognition and more efficient management. Prospective studies are needed to identify modifiable risk factors, improve device design and quality, and advise patients on use to potentially improve prosthesis lifetime.