Cranioplasty: why throw the bone flap out?

Patients who undergo decompressive craniectomy for intracranial hypertension often require interval cranioplasty. Many cranioplasty agents are currently in use. The authors suggest that storage of the patient's own bone flap in the subcutaneous tissue of the abdominal wall, is a safe, efficacious and cost-effective alternative to use of synthetic cranioplasty materials.

Langerhans cell (LC) proliferation mediates neonatal development, homeostasis, and inflammation-associated expansion of the epidermal LC network.

Most tissues develop from stem cells and precursors that undergo differentiation as their proliferative potential decreases. Mature differentiated cells rarely proliferate and are replaced at the end of their life by new cells derived from precursors. Langerhans cells (LCs) of the epidermis, although of myeloid origin, were shown to renew in tissues independently from the bone marrow, suggesting the existence of a dermal or epidermal progenitor. We investigated the mechanisms involved in LC development and homeostasis. We observed that a single wave of LC precursors was recruited in the epidermis of mice around embryonic day 18 and acquired a dendritic morphology, major histocompatibility complex II, CD11c, and langerin expression immediately after birth. Langerin+ cells then undergo a massive burst of proliferation between postnatal day 2 (P2) and P7, expanding their numbers by 10–20-fold. After the first week of life, we observed low-level proliferation of langerin+ cells within the epidermis. However, in a mouse model of atopic dermatitis (AD), a keratinocyte signal triggered increased epidermal LC proliferation. Similar findings were observed in epidermis from human patients with AD. Therefore, proliferation of differentiated resident cells represents an alternative pathway for development in the newborn, homeostasis, and expansion in adults of selected myeloid cell populations such as LCs. This mechanism may be relevant in locations where leukocyte trafficking is limited.

Investigation on drop penetration and wetting characteristics of powder-liquid systems in relation to the mixing of acrylic bone cement

This study investigated methyl methacrylate – polymethyl methacrylate powder bed interactions through droplet analyses, using model fluids and commercially available bone cement. The effects of storage temperature of liquid monomer and powder packing configuration on drop penetration time were investigated. Methyl methacrylate showed much more rapid imbibition than caprolactone due to decrease in both contact angle and fluid viscosity. Drop penetration of caprolactone through polymethyl methacrylate increased with decrease in bed macro-voids and increase in bulk density as predicted by the modified constant drawing area penetration model and confirmed by drop penetration images. Linear relationships were found between droplet mass and drawing area with imbibition time. Further experiments showed gravimetric analysis of the polymerised methyl methacrylate – polymethyl methacrylate matrix under various storage temperatures correlated with Reynolds number and Washburn analyses. These observations have direct implications for the design of mixing and delivery systems for acrylic bone cements used in orthopaedic surgery.