Effectiveness of an acellular synthetic matrix in the treatment of hard-to-heal leg ulcers

Hard-to-heal leg ulcers are a major cause of morbidity in the elderly population. Despite improvements in wound care, some wounds will not heal and they present a significant challenge for patients and health care providers. A multi-centre cohort study was conducted to evaluate the effectiveness and safety of a synthetic, extracellular matrix protein as an adjunct to standard care in the treatment of hard-to-heal venous or mixed leg ulcers. Primary effectiveness criteria were (i) reduction in wound size evaluated by percentage change in wound area and (ii) healing assessed by number of patients healed by end of the 12 week study. Pain reduction was assessed as a secondary effectiveness criteria using VAS. A total of 45 patients completed the study and no difference was observed between cohorts for treatment frequency. Healing was achieved in 35·6% and wound size decreased in 93·3% of patients. Median wound area percentage reduction was 70·8%. Over 50% of patients reported pain on first visit and 87·0% of these reported no pain at the end of the study. Median time to first reporting of no pain was 14 days after treatment initiation. The authors consider the extracellular synthetic matrix protein an effective and safe adjunct to standard care in the treatment of hard-to-heal leg ulcers.

International survey of rigid contact lens fitting

Purpose To determine the extent of rigid contact lens fitting worldwide and to characterize the associated demographics and fitting patterns. Methods Survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected between 1996 and 2011 were also analyzed to assess rigid lens fitting trends in seven nations during this period. Results Data were obtained for 12,230 rigid and 100,670 soft lens fits between 2007 and 2011. Overall, rigid lenses represented 10.8% of all contact lens fits, ranging from 0.2% in Lithuania to 37% in Malaysia. Compared with soft lens fits, rigid lens fits can be characterized as follows: older age (rigid, 37.3 ± 15.0 years; soft, 29.8 ± 12.4 years); fewer spherical and toric fits; more bifocal/multifocal fits; less frequent replacement (rigid, 7%; soft, 85%); and less part-time wear (rigid, 4%; soft, 10%). High-Dk (contact lens oxygen permeability) (36%) and mid-Dk (42%) materials are predominantly used for rigid lens fitting. Orthokeratology represents 11.5% of rigid contact lens fits. There has been a steady decline in rigid lens fitting between 1996 and 2011. Conclusions Rigid contact lens prescribing is in decline but still represents approximately 10% of all contact lenses fitted worldwide. It is likely that rigid lenses will remain as a viable, albeit increasingly specialized, form of vision correction.

An early assessment of silicone hydrogel safety : pearls and pitfalls, and current status

The contact lens industry has evolved and now provides many choices, including continuous wear, overnight orthokeratology, frequent-replacement lenses, daily-disposable lenses, and many alternatives in systems of care and maintenance. Epidemiologic studies to date have shown that how a lens is worn, particularly if worn overnight, can increase the risk of microbial keratitis. However, the risk of silicone hydrogel contact lenses worn on a continuous-wear basis has been evaluated only recently. This article summarizes the recent research data on extended-wear silicone hydrogel lenses and discusses the challenges of early evaluations of silicone hydrogel lens safety. Finally, the relevance of this information is discussed to practitioners and contact lens wearers making choices about the risks and benefits of different products and how they are used.

The changing face of contact lens wearers over 25 years

A combination of factors has dictated patterns of prescribing to contact lens wearers in different age groups over time, such as the evolution of manufacturing technology in bringing better lens designs and replacement frequency options; the aging population demographic; and the knowledge and attitudes of practitioners. Here we explore evolving lens fitting practices at the opposite poles of the age spectrum—children and presbyopes.

Globalisation of CL prescribing : the UK perspective

Globalisation is a concept that templates onto many aspects of the commercial world, and the contact lens field is no exception. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and mediumsized companies, often producing more specialist lenses, are also active in markets across the world.

Contact lens prescribing : USA vs the world

Along with other facets of commericialization, the contact lens market has become globalized during the past 30 years. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and medium-sized companies, often producing more specialized lenses, are also active in markets across the world.

Development of an integrated GIS and land use planning course : impacts of hybrid instructional methods

This study reports an action research undertaken at Queensland University of Technology. It evaluates the effectiveness of the integration of GIS within the substantive domains of an existing land use planning course in 2011. Using student performance, learning experience survey, and questionnaire survey data, it also evaluates the impacts of incorporating hybrid instructional methods (e.g., in-class and online instructional videos) in 2012 and 2013. Results show that: students (re)iterated the importance of GIS in the course justifying the integration; the hybrid methods significantly increased student performance; and unlike replacement, the videos are more suitable as a complement to in-class activity.

Development of Contact Lenses from a Biomaterial Point of View – Materials, Manufacture, and Clinical Application

Rigid lenses, which were originally made from glass (between 1888 and 1940) and later from polymethyl methacrylate or silicone acrylate materials, are uncomfortable to wear and are now seldom fitted to new patients. Contact lenses became a popular mode of ophthalmic refractive error correction following the discovery of the first hydrogel material – hydroxyethyl methacrylate – by Czech chemist Otto Wichterle in 1960. To satisfy the requirements for ocular biocompatibility, contact lenses must be transparent and optically stable (for clear vision), have a low elastic modulus (for good comfort), have a hydrophilic surface (for good wettability), and be permeable to certain metabolites, especially oxygen, to allow for normal corneal metabolism and respiration during lens wear. A major breakthrough in respect of the last of these requirements was the development of silicone hydrogel soft lenses in 1999 and techniques for making the surface hydrophilic. The vast majority of contact lenses distributed worldwide are mass-produced using cast molding, although spin casting is also used. These advanced mass-production techniques have facilitated the frequent disposal of contact lenses, leading to improvements in ocular health and fewer complications. More than one-third of all soft contact lenses sold today are designed to be discarded daily (i.e., ‘daily disposable’ lenses).

Introducing dynamics : a new approach to "new media" [Editorial]

The term ‘‘new media’’ has been in play for decades now, and one might be forgiven for wondering how much longer digital forms and platforms can really be called ‘‘new,’’ or even what the scholarship of new media contributes to knowledge. Is it possible to say new things about new media? We think so. This Companion not only demonstrates the variety, salience, and importance of new media studies but also proposes a distinctive approach to the topic : an approach we call ‘‘new media dynamics.’’ In this view, what’s interesting about ‘‘new media’’ is not novelty as such but dynamism. Capitalism, technology, social networks, and media all evolve and change, sometimes to our delight, sometimes our dismay. This incessant process of disruption, renewal, and eventual (if often partial) replacement is now one of humanity’s central experiences. This cutting-edge collection brings together a stellar array of the world’s top researchers, cultural entrepreneurs, and emerging scholars to give the dynamics of new media their first full-length, multidisciplinary, historical, and critical treatment. Across 34 chapters, an international line-up of the very best authors reflects on the historical, technical, cultural, and political changes that underlie the emergence of new media, as existing patterns and assumptions are challenged by the forces of ‘‘creative destruction’’ and innovation, both economic and cultural. At the same time they show that familiar themes and problems carry through from ‘‘old’’media – questions of identity, sexuality, politics, relationships, and meaning.

Mesenchymal stromal cells and the repair of cartilage tissue

Articular cartilage has a limited intrinsic repair capacity, and thus defects are more likely to further degrade rather than undergo spontaneous self-repair. Whilst a number of surgical techniques have been developed to repair cartilage defects, their efficacy is generally poor and total joint replacement remains the gold standard, albeit last resort, treatment option. Cell-based therapies hold the greatest promise, as they appear uniquely capable of generating de novo cartilage tissue. Two approved therapies (ACI and MACI) are based on the premise that the transplantation of ex vivo expanded autologous chondrocyte populations, harvested from a non-load bearing region of the same joint, could be utilized to effectively regenerate cartilage tissue in the primary defect site. These therapeutic strategies are partially limited by our inability to harvest and expand adequate numbers of autologous chondrocytes that retain the appropriate phenotype. By contrast, the harvest and expansion of large numbers of mesenchymal stem/stromal cells (MSC) derived from tissues such as bone marrow and adipose is comparatively straightforward and has become routine in laboratories worldwide. Additionally, our understanding of the biochemical and biophysical signals required to drive the chondrogenic differentiation of MSC is rapidly increasing. It is conceivable that in the near future MSC expansion and differentiation technologies will offer a means to generate sufficient cell numbers, of an appropriate phenotype, for use in cartilage defect repair. In this chapter we review the relative potential of MSC and their likely contribution to cartilage regeneration.

Kamouflage : loss-resistant password management

We introduce Kamouflage: a new architecture for building theft-resistant password managers. An attacker who steals a laptop or cell phone with a Kamouflage-based password manager is forced to carry out a considerable amount of online work before obtaining any user credentials. We implemented our proposal as a replacement for the built-in Firefox password manager, and provide performance measurements and the results from experiments with large real-world password sets to evaluate the feasibility and effectiveness of our approach. Kamouflage is well suited to become a standard architecture for password managers on mobile devices.

Stimulation of osteogenic and angiogenic ability of cells on polymers by pulsed laser deposition of uniform akermanite-glass nanolayer

Polymer biomaterials have been widely used for bone replacement/regeneration because of their unique mechanical properties and workability. Their inherent low bioactivity makes them lack osseointegration with host bone tissue. For this reason, bioactive inorganic particles have been always incorporated into the matrix of polymers to improve their bioactivity. However, mixing inorganic particles with polymers always results in inhomogeneity of particle distribution in polymer matrix with limited bioactivity. This study sets out to apply the pulsed laser deposition (PLD) technique to prepare uniform akermanite (Ca2MgSi2O7, AKT) glass nanocoatings on the surface of two polymers (non-degradable polysulfone (PSU) and degradable polylactic acid (PDLLA)) in order to improve their surface osteogenic and angiogenic activity. The results show that a uniform nanolayer composed of amorphous AKT particles (∼30nm) of thickness 130nm forms on the surface of both PSU and PDLLA films with the PLD technique. The prepared AKT-PSU and AKT-PDLLA films significantly improved the surface roughness, hydrophilicity, hardness and apatite mineralization, compared with pure PSU and PDLLA, respectively. The prepared AKT nanocoatings distinctively enhance the alkaline phosphate (ALP) activity and bone-related gene expression (ALP, OCN, OPN and Col I) of bone-forming cells on both PSU and PDLLA films. Furthermore, AKT nanocoatings on two polymers improve the attachment, proliferation, VEGF secretion and expression of proangiogenic factors and their receptors of human umbilical vein endothelial cells (HUVEC). The results suggest that PLD-prepared bioceramic nanocoatings are very useful for enhancing the physicochemical, osteogenic and angiogenic properties of both degradable and non-degradable polymers for application in bone replacement/regeneration.

Epidemiological and molecular features of dengue virus type-1 in New Caledonia, South Pacific, 2001–2013

Background The epidemiology of dengue in the South Pacific has been characterized by transmission of a single dominant serotype for 3–5 years, with subsequent replacement by another serotype. From 2001 to 2008 only DENV-1 was reported in the Pacific. In 2008, DENV-4 emerged and quickly displaced DENV-1 in the Pacific, except in New Caledonia (NC) where DENV-1 and DENV-4 co-circulated in 2008–2009. During 2012–2013, another DENV-1 outbreak occurred in NC, the third DENV-1 outbreak in a decade. Given that dengue is a serotype-specific immunizing infection, the recurrent outbreaks of a single serotype within a 10-year period was unexpected. Findings This study aimed to inform this phenomenon by examining the phylogenetic characteristics of the DENV-1 viruses in NC and other Pacific islands between 2001 and 2013. As a result, we have demonstrated that NC experienced introductions of viruses from both the Pacific (genotype IV) and South-east Asia (genotype I). Moreover, whereas genotype IV and I were co-circulating at the beginning of 2012, we observed that from the second half of 2012, i.e. during the major DENV-1 outbreak, all analyzed viruses were genotype I suggesting that a genotype switch occurred. Conclusions Repeated outbreaks of the same dengue serotype, as observed in NC, is uncommon in the Pacific islands. Why the earlier DENV-1 outbreaks did not induce sufficient herd immunity is unclear, and likely multifactorial, but the robust vector control program may have played a role by limiting transmission and thus maintaining a large susceptible pool in the population. Keywords: Dengue; Phylogeny; Genotype; Epidemics; New Caledonia

Silicate-based bioceramics for periodontal regeneration

Periodontal disease is characterized by the destruction of the tissues that attach the tooth to the alveolar bone. Various methods for regenerative periodontal therapy including the use of barrier membranes, bone replacement grafts, and growth factor delivery have been investigated; however, true regeneration of periodontal tissue is still a significant challenge to scientists and clinicians. The focus on periodontal tissue engineering has shifted from attempting to recreate tissue replacements/constructs to the development of biomaterials that incorporate and release regulatory signals to achieve in situ periodontal regeneration. The release of ions and molecular cues from biomaterials may help to unlock latent regenerative potential in the body by regulating cell proliferation and differentiation towards different lineages (e.g. osteoblasts and cementoblasts). Silicate-based bioactive materials, including bioactive silicate glasses and ceramics, have become the materials of choice for periodontal regeneration, due to their favourable osteoconductivity and bioactivity. This article will focus on the most recent advances in the in vitro and in vivo biological application of silicate-based ceramics, specifically as it relates to periodontal tissue engineering.

Residual stresses in rail-ends from the in-service insulated rail joints using neutron diffraction

Insulated rail joints (IRJs) are an integral part of the rail track signaling system and pose significant maintenance and replacement costs due to their low and fluctuating service lives. Failure occurs mainly in rail head region, bolt- holes of fishplates and web-holes of the rails. Propagation of cracks is influenced by the evolution of internal residual stresses in rails during rail manufacturing (hot-rolling, roller-straightening, and head-hardening process), and during service, particularly in heavy rail haul freight systems where loads are high. In this investigation, rail head accumulated residual stresses were analysed using neutron diffraction at the Australian Nuclear Science and Technology Organisation (ANSTO). Two ex-service two head-hardened rail joints damaged under different loading were examined and results were compared with those obtained from an unused rail joint reference sample in order to differentiate the stresses developed during rail manufacturing and stresses accumulated during rail service. Neutron diffraction analyses were carried out on the samples in longitudinal, transverse and vertical directions, and on 5mm thick sliceed samples cut by Electric Discharge Machining (EDM). For the rail joints from the service line, irrespective of loading conditions and in-service times, results revealed similar depth profiles of stress distribution. Evolution of residual stress fields in rails due to service was also accompanied by evidence of larger material flow based on reflected light and scanning electron microscopy studies. Stress evolution in the vicinity of rail ends was characterised by a compressive layer, approximately 5 mm deep, and a tension zone located approximately 5- 15mm below the surfaces. A significant variation of d0 with depth near the top surface was detected and was attributed to decarburization in the top layer induced by cold work. Stress distributions observed in longitudinal slices of the two different deformed rail samples were found to be similar. For the undeformed rail, the stress distributions obtained could be attributed to variations associated with thermo-mechanical history of the rail.