Diamond Concept as Principle for the Development of Spinal Cord Scaffold: A Literature Review

INTRODUCTION: Spinal cord injury (SCI) has been bringing detrimental impacts on the affected individuals. However, not only that, it also brings a tremendous effect on the socioeconomic and health-care system. Treatment regimen and strategy for SCI patient have been under further research. DISCUSSION: The main obstacles of regeneration on neuronal structure are the neuroinflammatory process and poor debris clearance, causing a longer healing process and an extensive inflammation process due to this particular inflammatory process. To resolve all of the mentioned significant issues in SCIs neuronal regeneration, a comprehensive model is necessary to analyze each step of progressive condition in SCI. In this review, we would like to redefine a comprehensive concept of the “Diamond Concept” from previously used in fracture management to SCI management, which consists of cellular platform, cellular inductivity, cellular conductivity, and material integrity. The scaffolding treatment strategy for SCI has been widely proposed due to its flexibility. It enables the physician to combine another treatment method such as neuroprotective or neuroregenerative or both in one intervention. CONCLUSION: Diamond concept perspective in the implementation of scaffolding could be advantageous to increase the outcome of SCI treatment.

Study of ergonomics in terms of angle of manipulation and angle of azimuth in laparoscopic splenectomy

As per baseball diamond concept of port position, experimentally it is well known that putting camera port in the line of target organ and working port equidistant from camera port such that they form a 30º angle each gives optimum ergonomic advantage. However while performing laparoscopic surgeries in humans it is seldom possible to achieve such port position. No such study has ever been attempted to find out value of angle of manipulation and angle of azimuth while performing laparoscopic procedure. Purpose of our study was to measure such angles in our patients during laparoscopic splenectomy (LS) and to verify the concept of baseball position of ports in the procedure. This was a prospective observational study where angle of manipulation between right and left working port of surgeon and angle of azimuth of both working instruments with the camera were measured intraoperatively. In our series of 12 patients who underwent LS in lateral position, we found angle of manipulation ranging from 41-85°. The azimuth angle between first working port (epigastric) and camera port was in the range of 22-45° and the azimuth angle between camera port and second working port was in the range of 19-40°. This was a first study that gave valuable insight into the application of theoretical concept of triangulation in port placement in LS. This study may guide the surgeons to measure and to modify the port position to gain advantage of better ergonomics and better long term health.

Pengaruh Fraud Diamond dan Religiusitas terhadap Kecurangan Akademik Mahasiswa Akuntansi

Higher education is expected to be able to produce professionals who are able to compete in the era of globalization both in science and in morals, however fraudulent practices are often found in the world of education which is often referred to as academic fraud. This study aims to determine the factors that influence student academic fraud by using the fraud diamond concept and religiosity. Collecting data in this study using online questionnaires and purposive sampling techniques with the criteria of active students who have taken auditing courses 2. The sample of this study was 80 active students of the Accounting Study Program at Universitas PGRI Yogyakarta, Universitas Negeri Yogyakarta, Universitas Muhammadiyah Yogyakarta, Universitas Teknologi Yogyakarta, and Universitas Sanata Dharma Yogyakarta. Data analysis techniques using multiple linear regression models and data testing using SPSS. The results of this study indicate that opportunity and rationalization have a significant positive effect on academic cheating while pressure, capability, and religiosity have no effect on academic cheating.

Treatment of Femoral Non-Union with the Gene-Activated Osteoplastic Material: А Case Report

Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions.Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points.Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.

Expression of VEGF in Peripheral Serum Is a Possible Prognostic Factor in Bone-Regeneration via Masquelet-Technique—A Pilot Study

Two-step Masquelet-technique established a new procedure in the treatment of osseous defects, addressing prerequisites postulated by the “diamond concept”. Increase in blood perfusion and growth factors are enhanced by the “Masquelet-membrane”. To describe this, we measured serum levels of Vascular Endothelial Growth Factor (VEGF) of patients with atrophic non-unions of long bones undergoing Masquelet-technique. From over 500 non-union patients undergoing Masquelet-technique with prospective follow-up we randomly selected 30 patients. 23 were included, 7 lost to follow-up or excluded because of incomplete data. Serum was drawn at specified intervals before and after surgery. Patients were followed for at least 6 months after step 2. Classification into both groups was performed according to radiological results and clinical outcome 6 months after step 2. Concentration of VEGF in patients’ serum was performed via ELISA. 14 achieved osseous consolidation (responder group), 9 cases did not (non-responder). Responders showed a significant increase of serum-VEGF in the first and second week when compared to the preoperative values of step 1. Non-responders showed a significant increase of VEGF in the second week after Steps 1 and 2. Comparison of groups showed significantly higher increase of serum-VEGF week2 after step 1 and preoperative to step 2 for responders. Results show one possibility of illustrating therapeutic progress by monitoring growth factors and possibly allowing prognostic conclusions thereof. This might lead to a more targeted treatment protocol.

Neuro-Muscular Dentistry: the “diamond” concept of electro-stimulation potential for stomato-gnathic and oro-dental conditions

Oro-Pharyngeal Dysphagia - or simply dysphagia - is the difficulty (persistent) in swallowing/passing food and/or liquid from the mouth to the pharynx into the esophagus and finally the stomach; a deglutition disorder (a symptom, by definition, often due to neuro-degenerative/−muscular, drug-induced or localized structural pathologies such as head and neck tumors, lesions and associated surgical and/or radiation injuries) linked to severe consequences on Quality of Life (QoL), including malnutrition, dehydration, and even sudden death. Likewise, Temporo-Mandibular Jaw and Joint disorder(s) – or simply TMD – is a multifactorial etiological condition, regularly encountered in the dental office. Whether due to malocclusion, bruxism, stress and/or trauma, TMD destabilizes the whole cranio-mandibular system structurally and functionally, via affecting mastication, teeth, supporting structures, comfort and aesthetics, and thus, QoL, again. While several treatment regimens do exist for such conditions, some of which have been standardized for use over the years, most continue to lack proper evidence-based literature support. Hence, (1) caution is to be exercised; and (2) the need for alternative therapeutic strategies is amplified, subsequently, the door for innovation is wide open. Indeed, neuromuscular electrical stimulation or “NMES”, is perhaps a fine example. Herein, we present the interested oro-dental health care provider with an up-dated revision of this therapeutic modality, its potential benefits, risks and concerns, to best handle the dysphagic patient: an intra-disciplinary approach or strategy bridging contemporary dentistry with speech and language therapy; a rather obscure and un-discovered yet critical allied health profession. A pre-clinical and clinical prospectus on employing inventive NMES-based regimens and devices to manage TMD is also highlighted.

Nonunion – consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society

Nonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as ‘mechanobiology’ or the ‘diamond concept’ determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding absolute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteoconductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction. Cite this article: EFORT Open Rev 2020;5:46-57. DOI: 10.1302/2058-5241.5.190037

Möglichkeiten der nicht operativen Behandlung von Pseudarthrosen

ZusammenfassungPseudarthrosen sind häufige Verletzungsfolgen nach Frakturen. Goldstandard der Behandlung dieser Frakturheilungsstörungen ist die operative Therapie basierend auf dem „Diamond Concept“. Unter bestimmten Voraussetzungen ist jedoch eine nicht operative Behandlung von Pseudarthrosen möglich. In der Folge werden die am häufigsten angewendeten konservativen Verfahren einschließlich Belastungssteigerung und biophysikalischer Maßnahmen (niedrig intensivierte gepulste Ultraschalltherapie, fokussierte hochenergetische extrakorporale Stoßwellentherapie, elektrische und elektromagnetische Therapie) beschrieben und die sinnvolle Indikationsstellung, die Vor- und Nachteile sowie der Stellenwert dieser Möglichkeiten diskutiert.