BACKGROUND: A two-stage revision remains the standard for managing chronic periprosthetic joint infection (PJI). Despite multiple spacer options, whether a particular one better resists biofilm formation remains unclear. Prefabricated polymethylmethacrylate (PMMA) articulating spacers containing antibiotics and a proprietary pore structure were developed to increase antibiotic elution characterized by a rapid burst phase for the initial 1 to 2 days and an extended slow-release phase for > 28 days. This in vitro study determined whether biofilm formation is prevented during the initial rapid burst phase and/or the slow-release phase.
METHODS: S. aureus-Xen36 was incubated in 1.5 ml of Luria-Bertani broth with PMMA discs with the proprietary pore structure either with or without gentamycin and vancomycin, or with \'Hoffman style\' positive-control discs (ultra-high molecular weight polyethylene (UHMWPE) or cobalt-chrome). Non-adherent bacteria were removed by three Phosphate Buffered Saline rinses every 20 to 24 hours. Planktonic bacterial growth in the culture broth and biofilm formation on the discs were measured by Colony Forming Unit (CFU) counting and resazurin reduction assays. Experiments were repeated > 4 times.
RESULTS: No detectable planktonic bacterial growth or biofilm formation occurred in cultures containing PMMA with antibiotics (≤ 15 CFUs/disc), whereas biofilms formed on PMMA without antibiotics, UHMWPE, and cobalt-chrome (1x107 to 4x108 CFUs/disc, P < 0.0001). Biofilm formation was confirmed by a 100-fold decrease in sensitivity to vancomycin. To determine whether the antibiotic slow-release phase is sufficient to block biofilm formation, PMMA discs with antibiotics were pre-eluted for 14 days with multiple saline changes prior to bacterial inoculation. After antibiotic elution, still no detectable biofilms formed on PMMA discs with antibiotics (≤ 15 CFUs/disc, P <0.0001).
CONCLUSIONS: Antibiotic release during both the initial and slow-release phases prevented biofilm formation on PMMA with the proprietary pore structure. This may translate into improved infection eradication rates clinically.

This study aimed to investigate the effect of acidulated phosphate fluoride (APF) application on filler-free polymethyl methacrylate (PMMA)-based resin blocks for computer-aided design/computer-aided manufacturing (CAD-CAM), focusing on their use in pediatric crowns. Three types of PMMA-based blocks for CAD-CAM were evaluated, and a composite resin block for CAD-CAM was used as a control. Statistical analysis (p<0.05) of the data revealed that all PMMA-based blocks showed significantly higher gloss levels than the composite resin blocks. Two PMMA-based blocks also demonstrated significantly lower Ra and Sa values. SEM images showed no irregular changes in the surface properties of the PMMA-based blocks compared to those of the composite resin block. These results are significant in meeting the increasing demand for esthetic restorative treatments in pediatrics, where APF is commonly used for caries prevention. PMMA-based resin blocks for CAD-CAM are an effective alternative to prevent esthetic degradation from gloss reduction and plaque accumulation.

CO2 laser machining is a cost effective and time saving solution for fabricating microchannels on polymethylmethacrylate (PMMA). Due to the lack of research on the incubation effect and ablation behavior of PMMA under high-power laser irradiation, predictions of the microchannel profile are limited. In this study, the ablation process and mechanism of a continuous CO2 laser machining process on microchannel production in PMMA in single-pass and multi-pass laser scan modes are investigated. It is found that a higher laser energy density of a single pass causes a lower ablation threshold. The ablated surface can be divided into three regions: the ablation zone, the incubation zone, and the virgin zone. The PMMA ablation process is mainly attributed to the thermal decomposition reactions and the splashing of molten polymer. The depth, width, aspect ratio, volume ablation rate, and mass ablation rate of the channel increase as the laser scanning speed decreases and the number of laser scans increases. The differences in ablation results obtained under the same total laser energy density using different scan modes are attributed to the incubation effect, which is caused by the thermal deposition of laser energy in the polymer. Finally, an optimized simulation model that is used to solve the problem of a channel width greater than spot diameter is proposed. The error percentage between the experimental and simulation results varies from 0.44% to 5.9%.

The control of Candida albicans biofilm formation on dentures made of poly(methyl methacrylate) (PMMA) is an important challenge due to the high resistance to antifungal drugs. Interestingly, the natural compounds undecylenic acid (UDA) and farnesol (FAR) both prevent C. albicans biofilm formation and could have a synergetic effect. We therefore modified PMMA with a combination of UDA and FAR (UDA+FAR), aiming to obtain the antifungal PMMA_UDA+FAR composites. Equal concentrations of FAR and UDA were added to PMMA to reach 3%, 6%, and 9% in total of both compounds in composites. The physico-chemical properties of the composites were characterized by Fourier-transform infrared spectroscopy and water contact angle measurement. The antifungal activity of the composites was tested on both biofilm and planktonic cells with an XTT test 0 and 6 days after the composites\' preparation. The effect of the UDA+FAR combination on C. albicans filamentation was studied in agar containing 0.0125% and 0.4% UDA+FAR after 24 h and 48 h of incubation. The results showed the presence of UDA and FAR on the composite and decreases in the water contact angle and metabolic activity of both the biofilm and planktonic cells at both time points at non-toxic UDA+FAR concentrations. Thus, the modification of PMMA with a combination of UDA+FAR reduces C. albicans biofilm formation on dentures and could be a promising anti-Candida strategy.

(1) Background: The addition of antibiotics to bone cements is a common practice in the treatment of periprosthetic joint infections. In revision cases, the amount and type of antibiotic is often insufficient and additional antibiotics must be added. The addition, however, changes the product itself, and the surgeon becomes the \"manufacturer\" of the bone cement. PMMAe wished to clarify whether the admixture of antibiotics changes the mechanical stability of the bone cements used and if the added antibiotics were still functional and released in sufficient quantities. (2) Methods: We compared two industrially manufactured vancomycin-containing PMMA cements; the low-viscous VancogenX® (TECRES, Sommacampagna, Italy) and the high-viscous Copal® G+V (Heraeus Medical GmbH, Wehrheim, Germany), with two PMMA cements loaded with aminoglycosides, to which 2.0 g of vancomycin (Hexal CT1631) were manually added-the high-viscous Smartset® GHV and the medium-viscous Antibiotic Simplex with Tobramycin (antibiotic Simplex® T). Test specimens of the bone cements were used to determine mechanical stability (bending strength and bending module), and the release of the antibiotics was determined by HLPC and modified Kirby-Bauer assays. (3) Results: All tested bone cements showed an initial high release within the first hours. Repeated testing after 24 h showed a reduced efficacy of VancogenX® and Smartset® GHV in Kirby-Bauer assays. Long-time release over days showed a release of functional antimicrobial active ingredients over this period of time in anti-microbial assays, but no activity of VancogenX® from day 21 onward. No significant differences in the ISO bending modules could be detected, but in contrast to the bending module, the ISO bending strength was substantially reduced by 10-15 mPal in comparison to both cements of the reference group. The Simplex®T met just the ISO 5833; the Smartset® GHV did not after adding vancomycin. (4) Conclusions: In conclusion, the manual addition of 2 g of vancomycin to 40 g of PMMA powder is recommended for the treatment of methicillin-resistant staphylococci. Vancomycin is released over a period of 42 days with concentrations above the MIC for typical staphylococci. The mechanical properties of the PMMA just met, or did not fulfill, ISO mechanical specification. Copal® G+V showed a better elution than VancogenX® over time.

UNASSIGNED: Polymethylmethacrylate (PMMA) bone cement is extensively used in spinal procedures such as vertebroplasty and kyphoplasty, while its use in percutaneous cement discoplasty (PCD) is not yet widely spread. A main issue for both application sites, vertebra and disc, is the mismatch in stiffness between cement and bone, potentially resulting in adjacent vertebral fractures and adjacent segment disease. Tailoring the cement modulus using additives is hence an interesting strategy. However, there is a lack of data on the tensile and tension-compression fatigue properties of these cements, relevant to the newly researched indication of PCD.
UNASSIGNED: A commercial PMMA cement (VS) was modified with 12%vol of linoleic acid (VSLA) and tested for quasi-static tensile properties. Additionally, tension-compression fatigue testing with amplitudes ranging from +/-5MPa to +/-7MPa and +/-9MPa was performed, and a Weibull three-parameter curve fit was used to calculate the fatigue parameters.
UNASSIGNED: Quasi-static testing revealed a significant reduction in VSLA\'s Young\'s Modulus (E=581.1±126.4MPa) compared to the original cement (E=1478.1±202.9MPa). Similarly, the ultimate tensile stress decreased from 36.6±1.5MPa to 11.6±0.8MPa. Thus, VSLA offers improved compatibility with trabecular bone properties. Fatigue testing of VSLA revealed that as the stress amplitude increased the Weibull mean number decreased from 3591 to 272 and 91 cycles, respectively. In contrast, the base VS cement reached run-out at the highest stress amplitude. However, the lowest stress amplitude used exceeds the pressures recorded in the disc in vivo, and VSLA displayed a similar fatigue life range to that of the annulus fibrosis tissue.
UNASSIGNED: While the relevance of fully reversed tension-compression fatigue testing can be debated for predicting cement performance in certain spinal applications, the results of this study can serve as a benchmark for comparison of low-modulus cements for the spine. Further investigations are necessary to assess the clinical feasibility and effectiveness of these cements.

Cranioplasty is a common surgical procedure used to restore the shape of the calvaria. Autogenous bone flaps provide biological repair with the least morbidity to the donor location. One method for reusing bone autograft during cranioplasty involves low-temperature preservation followed by autoclaving. According to the literature, there was a good to modest improvement in the skull\'s symmetry, cosmesis, scars, and contour. It was determined that autoclaved frozen autogenous cerebral bone flaps are a safe and reliable method of cranioplasty. Despite its apparent simplicity, cranioplasty has been found to carry a relatively high complication rate, ranging from 12% to 50%, which starkly contrasts with the standard elective craniotomy, with a complication rate typically ranging from 24% to 60%. Complications associated with autogenous bone flap procedures are varied. The presented case report primarily focuses on the duplication of autogenous bone flaps by using clear polymethyl methacrylate.

BACKGROUND: Microcrystalline cellulose (MCC) is a novel organic material developed by one of the authors in this study. When MCC was incorporated with conventionally available denture base resin, it demonstrated increased flexural strength and flexural modulus. However, it was speculated that because the material is organic, it can promote the growth of Candida. The purpose of this study is to evaluate the Candida albicans biofilm formation on polymethyl methacrylate (PMMA) denture base resin incorporated with MCC.
METHODS: MCC is an organic material extracted from the oil palm empty fruit bunch (OPEFB). The growth of C. albicans and biofilm formation in three test groups were compared by biofilm assay and imaging techniques like microscopy (by safranin staining) and scanning electron microscopy. The three test groups were comprised of MCC-reinforced PMMA containing OPEFB fibers of 50-micrometer thickness at 5% weight reinforcement, conventionally and commercially available heat cure PMMA, and an empty well to assess any discrepancies from the environment.
RESULTS: The test groups showed increased biofilm formation by C. albicans compared to commercially and conventionally available heat cure PMMA. Reinforcement with MCC showed higher biofilm formation of 1.43 times higher compared to conventional PMMA. Biofilms formed by Candida albicans on MCC-reinforced PMMA appeared heterogeneous in structure, comprised of yeast cells and hyphae, surrounded by a higher density of polysaccharide extracellular matrix material compared to that of conventionally available heat cure PMMA.
CONCLUSIONS: Biofilm formation is increased in denture base resin incorporated with MCC. More investigation is warranted to study the antifungal efficacy of the addition of antifungal agents to the reinforced denture base resin.

PMMA/PEG and PMMA/PEG doped with SiO2, TiO2, and Al2O3 were fabricated using the solution-casting technique. The composites were characterized by X-ray diffraction and scanning electron microscopy (FE-SEM), which revealed that the amorphous nature of PMMA/PEG blend doped with Al2O3 was hindered by the crystalline nature of those doped with SiO2 and TiO2. The absorption of PMMA/PEG blend doped with Al2O3 is higher, band gap energies were decreased from 4.90 eV for PMMA/PEG blend to 4.03 eV, 3.09 eV, and 2.09 eV for SiO2, TiO2, and Al2O3 doped PMMA/PEG blend, respectively. The dielectric constant, ε\' has a high value (2 × 104) for samples PMMA/PEG and SiO2/PMMA/PEG. While dielectric loss ε ″ -values decreased to < 100 for TiO2/PMMA/PEG and Al2O3/PMMA/PEG. Further, the fabricated composite SiO2/PMMA/PEG led to improvement the optical and dielectric properties compared with PMMA/PEG for optoelectronic such as manufacturing of optical fiber cables application. The results show TiO2/PMMA/PEG and Al2O3/PMMA/PEG are multifunctional can be used as low-permittivity nanodielectric and substrates to design the next generation of flexible electronic devices.

The escalating concern surrounding microplastic (MP) pollution necessitates urgent attention and the development of rapid techniques for quantifying extremely low concentrations. Surface-enhanced Raman spectroscopy (SERS) has emerged as a promising method due to its simplicity, high sensitivity, and rapid quantification capabilities. Herein, the efficacy of gold-silver alloy nanoparticles (3DPAu-Ag) substrates for detecting poly(methyl methacrylate) (PMMA) and polystyrene (PS) MPs is investigated. The 3DPAu-Ag SERS substrates are fabricated using the meniscus-confined electrochemical 3D printing (MC-E3DP) process, employing a nozzle of 0.8 mm size with 2.5 V potential at a printing speed of 0.4 mm s-1. The proposed SERS substrates exhibit exceptional sensitivity and are capable of detecting PMMA concentrations as low as 0.2 μg mL-1 and PS concentrations of 1.2 μg mL-1 within the ranges of 1-103 μg mL-1 and 10-104 μg mL-1, respectively. Remarkable enhancement factors (EFs) of up to 3.2 × 104 for PMMA and 9.3 × 103 for PS are achieved, underscoring the substrates\' effectiveness. Furthermore, the investigation demonstrates outstanding uniformity and reproducibility of the 3DPAu-Ag substrates, with relative standard deviation (RSD) values of only 4.1 and 6.4%, respectively, across 31 and 5 measurements. Additionally, a minimal 17% decrease in the initial SERS signal value after 5 weeks highlights the substrates\' high stability. This not only highlights the superior quality of the substrates but also positions them ahead of previously reported works in the literature. Moreover, this study also comes up with a plausible mechanism for MPs SERS detection facilitated by the 3DPAu-Ag substrates, offering insights into the underlying processes. Overall, 3DPAu-Ag substrates show promise for sensitive, stable MP detection, which is crucial for environmental monitoring.