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Biomedical subjects

A Toni

Publications and source records attributed to A Toni.

At least 73 records · Page 4Linked to original sources
PubMed2000

In vitro testing of ten bone cements after different time intervals from polymerization.

Biological response of cells to implanted bone cement is a fundamental but often neglected issue in successful cemented implants. In this study, ten acrylic bone cements for orthopedics were assayed using two different in vitro testing methods on L929 cells. The cements were mixed as prescribed, cured for either 1 h or 7 days and then extracted in minimum essential medium (MEM) according to the ISO standard for the preparation of samples. For the evaluation of cytotoxicity, the neutral red uptake assay (NRU) and the incorporation of propidium iodide (PI) were used to detect the viability/death of cells. The two methods were shown to be well correlated (p < 0.0001) in the case of both the 1-h and the 7-day extracts. Two cements, i.e. CERIM LT and CMW2, were found to be toxic after 1-h curing through both the spectrophotometric NRU assay and the cytofluorometric assay with PI. After 7-day curing, these two cements, as well as the Zimmer-low viscosity cement, were toxic according to the NRU assay. The toxic effect of all the cements disappeared after dilution of extracts 1:2 with MEM, except in the case of CERIM LT. In the search for the component inducing the toxic effect, the possible contribution of the residual monomer was discarded on the basis of literature data and the influence of various other factors was analyzed, including the contrast medium (barium sulphate or zirconium dioxide) and the concentrations of N,N-dimethyl-paratoluidine and of benzoyl peroxide (< 1% or > or = 1%). Unlike zirconium dioxide, barium sulphate was found to damage the cells at the 1-h endpoint. Benzoyl peroxide at concentration > or = 1% was found to affect cells at the same endpoint, whereas dimethylparatoluidine had no effect regardless of the proportion.

Animals↗
PubMed2000

Modulation of pro- and anti-apoptotic genes in lymphocytes exposed to bone cements.

The ability of bone cements to modify the apoptotic program in activated immune cells and the mechanisms by which they act were evaluated. Mononuclear cells were collected from healthy individuals, cultured for 4 and 24 h with phytohemoagglutinina-P and cement extracts and then tested to assess: (a) cell viability; (b) early apoptotic events, by Annexin V/propidium iodide staining; and (c) the expression of pro- (p53, c-myc, ICE) and anti-apoptotic (bcl-2) genes. After 4 h three cements were able to increase significantly the percentage of apoptotic cells, while after 24 h no differences were found. The proportion of dead cells was not significantly changed at either culture time. The simultaneous expression of both pro-apoptotic (ICE, c-myc, p53) and antiapoptotic genes (bcl-2) was investigated only with regard to the materials which induced significant changes in apoptosis: two cements induced the p53 expression, while the third down-regulated bcl-2. As apoptosis regulates the balance of immune response, the authors recommend that the interaction between materials and immune cells should be assessed, so that the use of pro-apoptotic materials may be avoided in patients with immune defects.

Annexin A5↗
PubMed2000

Alumina femoral head fracture: an in vitro study.

A fracture of a ceramic femoral head is reported in this study. Fractures of ceramic femoral heads are uncommon and reports on this complication are rare. After 3 million cycles, on a twelve station hip simulator that tested alumina femoral head against polyethylene acetabular cup, fracture of the ceramic ball was observed. The retrieved specimen consisted of three large ceramic fragments from the same ceramic femoral head, a polyethylene acetabular cup and a stainless steel jig. Careful and detailed examination of the removed components was made. The fracture of the ceramic ball resulted in damage to the metal taper of the jig component which was fixed into the simulator.

Acetabulum↗
PubMed1999

Mixed oxides prosthetic ceramic ball heads. Part 1: effect of the ZrO2 fraction on the wear of ceramic on polythylene joints.

Although mixed oxides ceramics have been indicated in the literature as a promising compromise between strength and wear, to the authors' knowledge no reports are available on the influence of the percentage of zirconia in ceramic femoral heads when sliding against polyethylene cups. Two types of mixed oxides ceramic ball heads (alumina plus, respectively, 60 and 80% of zirconia) were compared to pure zirconia and pure alumina heads in terms of wear behaviour against UHMWPE in a hip joint simulator. Polyethylene cups and ceramic femoral heads were fixed on a simulator apparatus with a sinusoidal movement and load in presence of bovine calf serum. The experimental results did not show significant difference between the two experimental ceramic materials or in comparison with pure materials. Considering that all specimens, regardless of the material, had the same level of surface roughness, this roughness factor seems to have a more relevant role than the mix of oxides used to manufacture the ceramic head. Wear tests are conducted on materials used in prosthetic hip implants in order to obtain quality control and to acquire further knowledge of the tribological processes that involve joint prostheses, therefore reducing the risk of implant failure of innovative prostheses.

Animals↗
PubMed1999

Mixed-oxides prosthetic ceramic ball heads. Part 2: effect of the ZrO2 fraction on the wear of ceramic on ceramic joints.

Three different types of mixed-oxides ceramic ball heads have been investigated for their wear behaviour against acetabular cups of the same materials in a hip joint simulator. Mixed-oxides ceramics have been indicated in literature as a promising compromise between strength and wear but no reports are available on the influence of a percentage of zirconia in a ceramic femoral head when sliding against itself. Mixed-oxides ceramic acetabular cups and femoral heads were tested on a simulator apparatus with a sinusoidal load in presence of bovine calf serum. The experimental results did not show any significant difference between the experimental and commercial ceramic material couplings. These results were found to be in accord with those developed in Part 1.

Acetabulum↗
PubMed1999

A study of the application sharing capabilities in telemedicine.

The main aim of this study was to find out if the image format (TIFF or JPEG) influenced the time delay for transferring radiological images by the application sharing tool of a desktop videoconferencing system. The second task of the study was to define a procedure that optimized the time delay to load and remotely visualize the images. The results were achieved by applying a test procedure called 'benchmark protocol'. The videoconferencing system used for the test was Intel ProShare 200 v2.0. The image transfer was performed by a BRI ISDN connection. We showed that the image format had no significant influence on the time delay. We presented an optimal procedure for image transfer. Furthermore, store and forward procedures with simple file transfer were shown to be inferior to the use of application sharing. For radiological image transfer we recommend to use lossless file formats and application sharing with the image already loaded in because this method achieves the lowest time delays.

Computer Communication Networks↗
PubMed1999

The Telemedicine benchmark--a general tool to measure and compare the performance of video conferencing equipment in the telemedicine area.

In this paper, we describe the 'Telemedicine Benchmark' (TMB), which is a set of standard procedures, protocols and measurements to test reliability and levels of performance of data exchange in a telemedicine session. We have put special emphasis on medical imaging, i.e. digital image transfer, joint viewing and editing and 3D manipulation. With the TMB, we can compare the aptitude of different video conferencing software systems for telemedicine issues and the effect of different network technologies (ISDN, xDSL, ATM, Ethernet). The evaluation criteria used are length of delays and functionality. For the application of the TMB, a data set containing radiological images and medical reports was set up. Considering the Benchmark protocol, this data set has to be exchanged between the partners of the session. The Benchmark covers file transfer, whiteboard usage, application sharing and volume data analysis and compression. The TMB has proven to be a useful tool in several evaluation issues.

Benchmarking↗
PubMed1999

Technical validation of low-cost videoconferencing systems applied in orthopaedic teleconsulting services.

Investigation on the applicability of low-cost videoconferencing (VC) for health care services is becoming a real need. Reduced resources drive the administrators to evaluate inexpensive solutions for telemedicine. Considering this scenario, this work is a preliminary step to validate, from a technical point of view, if low-cost VC systems could be suitable for orthopaedic teleconsulting services. For this purpose, four different videoconferencing systems were tested. Each VC system was composed of a computer and a VC device installed in. VC devices were chosen among the most popular and distributed products (made by Intel, PictureTel and Aethra). The Telemedicine Benchmark, a specific tool defined by the authors, was applied to measure the overall systems performances in terms of time delays during basic rate ISDN connections (128 Kbit/s). Results showed that it is possible to apply low-cost videoconferencing systems for orthopaedic teleconsulting services. Most of the systems provided acceptable performance for medical image visualization and real time joint working. Further developments are recommendable to enhance the VC software tools capabilities and to improve software-user interface. reserved.

Costs and Cost Analysis↗
PubMed1999

Wear debris and cytokine production in the interface membrane of loosened prostheses.

In this study, thirty-nine patients were examined. All of them suffered from hip joint prostheses loosening and underwent revision surgery. Bioptic samples were collected at the interface between bone and implant either at the stem or cotyle level. Immunohistochemistry was performed to detect IL-1alpha, IL-1beta, IL-6 and TNF, cytokines that directly cause bone resorption and indirectly induce synthesis of other bone resorbing cytokines. Quantitative analysis of the positive cells and correlation with clinical data was performed. It resulted that there is a great variability in positive cells for cytokines according to the harvest site; anyway, cytokines tend to be higher in patients carrying a joint prosthesis with polyethylene acetabular component and it is associated with plastic wear particles, even though there is no direct correlation between wear amount and cytokine levels. There is a statistically significant negative correlation between metal wear and a cytokine (IL-6); cytokines levels do not depend on the implant time to failure and do not correlate with pain score. As expected, cytokines levels tend to be lower in subjects being treated with non-steroidal antiinflammatory drugs. It can be concluded that plastic wear is the factor inducing the highest cytokine levels in the tissues around the prosthesis at the interface; cytokines that are an indicator of osteolysis risk.

Adult↗
PubMed1999

Low-cost ISDN videoconferencing equipment for orthopaedic second opinions.

We validated the application of low-cost ISDN videoconferencing equipment for telemedicine. A telemedicine benchmark was designed and four different office videoconferencing systems were evaluated, all using basic-rate ISDN connections (128 kbit/s). All the low-cost systems showed generally good or acceptable performance for clinical use. We also investigated the feasibility of videoconferencing for an orthopaedic second-opinion service. Eight point-to-point conferences were conducted to discuss real clinical cases by use of interactive sharing of medical images. The average duration of each session was 35 min. Encouraging results were obtained.

Costs and Cost Analysis↗
PubMed1999

Guidelines for multipoint videoconferencing using low-cost, PC-based equipment.

We have compiled a set of guidelines for effective multipoint videoconferencing carried out with low-cost, PC-based systems. The guidelines are based on experience gained during multipoint videoconferences in epidemiology and orthopaedics/radiology. Joint data inspection and manipulation were carried out by application sharing between the PCs. The guidelines are categorized by the time of their application and also by their content. For effective multipoint videoconferences, preparation of the agenda and of digital documents is mandatory. The prevention of echo effects and half-duplex audio connections are of special importance. A protocol to optimize the order of speakers increases the efficient use of conference time. The guidelines worked well when used in a multisite research project and addressed the most important weak points of multipoint videoconferences using low-cost equipment.

Costs and Cost Analysis↗
PubMed1999

Hip prothesis: an in vitro wear protocol based on a comparison between gravimetric and profilometric analysis.

Ultra high molecular weight polyethylene acetabular cups were analysed by means of a shadowgraph method (using a profile projector) to measure linear wear. The results were compared with those of previous wear tests performed on a hip joint simulator. Twelve polyethylene acetabular cups were analysed. The specimens were evaluated visually for evidence of polyethylene wear. Examination of the polyethylene inner surface did not reveal evidence of surface failure such as delamination, fatigue cracks or scratches. Volumetric wear was calculated using a formula based on dimensional change due to the penetration of the femoral head in the acetabular cup. It was found to be of the same order of magnitude as the wear obtained in in vitro experimental tests.

Biomechanical Phenomena↗
PubMed1998

A comparative study on different methods of automatic mesh generation of human femurs.

The aim of this study was to evaluate comparatively five methods for automating mesh generation (AMG) when used to mesh a human femur. The five AMG methods considered were: mapped mesh, which provides hexahedral elements through a direct mapping of the element onto the geometry; tetra mesh, which generates tetrahedral elements from a solid model of the object geometry; voxel mesh which builds cubic 8-node elements directly from CT images; and hexa mesh that automatically generated hexahedral elements from a surface definition of the femur geometry. The various methods were tested against two reference models: a simplified geometric model and a proximal femur model. The first model was useful to assess the inherent accuracy of the meshes created by the AMG methods, since an analytical solution was available for the elastic problem of the simplified geometric model. The femur model was used to test the AMG methods in a more realistic condition. The femoral geometry was derived from a reference model (the "standardized femur") and the finite element analyses predictions were compared to experimental measurements. All methods were evaluated in terms of human and computer effort needed to carry out the complete analysis, and in terms of accuracy. The comparison demonstrated that each tested method deserves attention and may be the best for specific situations. The mapped AMG method requires a significant human effort but is very accurate and it allows a tight control of the mesh structure. The tetra AMG method requires a solid model of the object to be analysed but is widely available and accurate. The hexa AMG method requires a significant computer effort but can also be used on polygonal models and is very accurate. The voxel AMG method requires a huge number of elements to reach an accuracy comparable to that of the other methods, but it does not require any pre-processing of the CT dataset to extract the geometry and in some cases may be the only viable solution.

Algorithms↗
PubMed1997

Fretting wear in a modular neck hip prosthesis.

In vitro cyclic load fretting tests were conducted on a prototype of a cementless, modular neck, hip prosthesis. The study had three major objectives: to determine the amount of fretted material in the tapered-neck joint under various load cycle amplitudes, to determine the fretting damage evolution, and to determine the effect of different-sized stem bodies on the production of debris. All the tests produced some fretting microdamage on the tapered surface although the extent was quite different among test groups. The amount of abraded material increased almost linearly with the applied load magnitude but not with the number of load cycles. The amount of weight loss was higher in the large stem bodies than in the small ones. Weight loss ranged from 0.28 +/- 0.10 mg for small stem bodies loaded 5.5 million times up to 2300N to 2.54 +/- 0.53 mg for large stem bodies located 20 million times up to 3300N. Considering the large-size stem results, and assuming one million load cycles between 300N and 3300N to be the average yearly load history, the modular neck tapered joint would produce 0.6 mg/year of metal debris. The clinical impact of this observation is unknown; however, some of the literature on the presence of metal in patient tissues and fluids supports the hypothesis that a normal and stable prosthesis is likely to produce less than 10 mg/year of metal debris. Thus, a further production of 0.6 mg/year due to the modular neck should not have any significant effect.

Alloys↗
PubMed1997

Biomechanical validation of a new nail-plate for the repair of stable proximal femoral fractures.

The mechanical performance and the stress shielding effects of the Howmedica Spherolock MKII implant were evaluated. Three types of stable proximal femoral fractures were created in composite femurs and fixed with the nail-plate. The femurs were loaded to failure, and the yield strength, stiffness, and failure modes were noted. Additional intact composite femurs were fitted proximally with strain gauges, and the strain was examined under load. The femurs then underwent intertrochanteric fracture, plating, and re-testing. Comparative analysis showed that while the Spherolock system is less strong and stiff than other commonly used implants, it provides excellent and uniform load transfer across the fracture site. Varus rotation of the femoral head under load tended to open the fracture gap and localize the resultant load medially. Stress shielding of the calcar was less than 25% of the applied load even in the worst case. This very low stress shielding behavior was attributed mainly to the implant's low stiffness.

Biomechanical Phenomena↗
PubMed1997

Relationship between bone-prosthesis bonding and load transfer in total hip reconstruction.

The effect of bone-prosthesis bonding on proximal load transfer is investigated using a coupled experimental and finite element analysis on a synthetic femur. Three-dimensional finite element models for an intact femur and a femur implanted with a cementless prosthesis were constructed from the experimental models used, and the proximal femoral strains recorded for two loading conditions approximating a one-legged stance. The approach was used to investigate a press-fitted and a fully bonded bone-prosthesis structure to identify the stem-bone behaviour for both interface conditions and their implications for proximal bone load transfer. Regression slopes close to unity indicated that the finite element predictions were an accurate estimate of the experimental measurements. Physiological surface strains were recorded only when the abductor force was included in the loading. Meanwhile, experimental measurements and numerical predictions showed that a different load transfer pattern is to be expected for normally press-fitted and glued press-fitted stems. The finite element model for the treated femur, modelling both interface conditions correlated very well with the experimental model. These finite element models subsequently modified and used to analyse the effect of different interface conditions predicted a significant increase in the load transfer to the proximal calcar bone when only proximal bonding is achieved. This study suggests that information obtained for the assessment and prediction of total hip arthroplasty longevity by numerical and experimental techniques used together and in parallel is of greater value than either technique used alone. The employment of a femur analogue as featured in this study is also shown to be a suitable alternative to cadaveric specimens in such an analysis.

Biomechanical Phenomena↗
PubMed1996

Design-related fretting wear in modular neck hip prosthesis.

An accelerated cyclic loading corrosion test was used to determine the corrosion behavior of a commercial (GSP) and a prototype titanium hip prosthesis each with a modular neck. Four GSP and four prototype stems were subjected to a 2-Hz cyclic load ranging between 200 and 2,100 N for 1,000,000 cycles. Three stems were tested in an environment of FeCl3 solution, three stems were tested in Ringer's solution, and two stems were tested in air. After cyclic loading, the specimens were carefully examined with optical and scanning electron microscopy (SEM). None of them showed macroscopic or microscopic signs of corrosion, regardless of the environment to which the specimens were subjected. However, macroscopic evidence of mechanical fretting was present at the neck-stem modular junction, primarily concentrated at the medial contact point between stem and neck, especially for the prototype stems. SEM analysis confirmed these observations. The appreciable differences observed between the two designs suggest that the problem can be minimized or eliminated with an accurately designed taper fitting.

Chlorides↗