Plenary Invited Speakers

Iulian Antoniac

Prof. Iulian Antoniac obtained his M.E., Ph.D. and Postdoc degrees in Materials Science at the University Politehnica of Bucharest. Since 2002, he has been associated with the Medical Engineering program in the Faculty Materials Science and Engineering, University Politehnica of Bucharest, which is focused on biomaterials obtaining and characterization, medical image processing and the development of new implants for medical applications.

Professor Iulian Antoniac is the leader of the Biomaterials Group, head of the Biomaterials & Interface Phenomenon Laboratory, full professor at Faculty Materials Science and Engineering. He was appointed Vice Dean of Faculty Materials Science and Engineering and member of the Senate of University Politehnica of Bucharest in 2016.

Professor Iulian Antoniac has published widely, with over 200 papers published in peer-reviewed journals and conference proceedings, 7 patents, more than 20 books and books chapters (like Handbook of Bioceramics and Biocomposites) and more than 50 invited lectures at conferences focused on biomaterials, bioceramics and materials science. His scientific activity is materialized in many publications with relevant citation: ISI Web of Knowledge citation 233 (h-index 10); Scopus citation 580 (h-index 12); Google Scholar citation: 692 (h-index 14).He was member in the research team of 47 projects – in 13 of them as director or PI, and also as team leader or management group member in various international projects in different framework (FP5, FP7, COST, INTERREG).

He is Editor in Chief for the journal Materials Science Forum, editorial board member for other journals and reviewer for more than 40 journals.In 2005, he received the Daniel Bunea Award from the Romanian Society for Biomaterials. Also, he receives many awards for their patents at various international fairs and exhibitions dedicated to patents. He is currently President of the Romanian Society for Biomaterials (SRB), Former President and permanent Member of Executive Committee of the International Society for Ceramics in Medicine (ISCM).

Professor Iulian Antoniac research interests include: metallic biomaterials for orthopedic and dental applications, bioceramic coatings, biocomposites, biopolymers, retrieval analysis of explants, microscopy techniques for materials characterization, bone regeneration, physical and chemical characterization of nano- and micro- particles for biomedical application.

Present areas of research work: bioceramics, biocomposites, biodegradable metallic biomaterials, surface modification, interaction tissue-biomaterials, biointerfaces, tissue engineering, bone regeneration, retrieval and failure analysis of orthopedic and dental implants.

Role of degradable magnesium alloys in medicine

Vasile-Iulian Antoniac^1,2

¹Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei St., 060042 Bucharest, Romania

²Academy of Romanian Scientists, 54 Splaiul Independentei St., 050094 Bucharest, Romania

Biodegradable metals are a new paradigm for orthopedic implants because they promote bone formation and sustain the bone healing and remodeling process through a gradual load transfer between implant and tissues. In addition, they are designed to provide sufficient mechanical strength at the beginning of the treatment, and then, after their degradation, a complete bone healing process is observed. Magnesium (Mg)-based alloys have become an important category of materials that is attracting more and more attention due to their high potential use as orthopedic temporary implants.

In this paper, a detailed overview covering alloy development and manufacturing techniques is described. The key features for biodegradable Mg alloys, suitable for temporary orthopedic implants, are biocompatibility, proper mechanical properties to assure mechanical integrity until the fracture healing, degradation rate, and dynamic corrosion, according to the clinical needs. The effective biofunctionality of the biodegradable temporary orthopedic implants can be evaluated only by in vivo testing, on animal models, followed by clinical trials. In addition, the new bone formation, bone–implant interface, and inflammatory reactions can be evaluated. Special attention is given to animal testing, and the clinical translation is also reviewed, focusing on the main clinical cases that were conducted under human use approval.

Different research groups demonstrated that the initial difficulties with in vitro testing appear to be surpassed, and the testing procedures and the mediums used are quite well accepted. Animal testing is widely presented in the literature, and the main species used for in vivo experiments are mice, rats, rabbits, dogs, goats, and mini pigs. The advantages and drawbacks of these animal models were highlighted, and they can be correlated also with the in vitro tests.

The objective of this paper was to present a systematic investigation on different Mg alloys from different system. Future research must be concentrated on the direction of alloys with a low degradation rate and an improved mechanical strength, in order to solve load-bearing zone fractures. New designs for orthopedic implants are possible to be developed in the near future, especially for foot and ankle surgery, if the researchers better correlate the clinical needs with each Mg-based alloy biofunctional properties. This is because, in the case of biodegradable Mg-based alloys, we cannot conclude that a universally accepted alloy for any orthopedic applications exists. Further research that includes human studies is indicated for each newly developed implant.

ACKNOWLEDGEMENTS: –

„This work was supported by a grant of the Romanian Ministry of Education and Research, CNCS-UEFISCDI, project number PN-III-P4-ID-PCE-2020-2591, within PNCDI III.”.

References.

[1] I. Antoniac, M. Miculescu, V. Manescu, A. Stere, P.H. Quan, G. Paltanea, A. Robu, and K. Earar, Materials, 15(3), 1148 (2022).

[2] I.V. Antoniac, Handbook of Bioceramics and Biocomposites; Springer International Publishing, Cham, Switzerland, (2016).

Radu Fleaca

Dr. Radu Fleaca earned his MD degree from the University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca in 1992, he completed his training in Emergency Medicine in 1998 and in Orthopaedic and Trauma Surgery in 2002. He sustained his PhD Thesis in 2010 at the University Lucian Blaga of Sibiu. He serves as Associate Professor at the University Lucian Blaga of Sibiu Faculty of Medicine Department of Orthopedics and Trauma Surgery. Since 2020 he is Dean of the Faculty of Medicine of Lucian Blaga University of Sibiu. Dr. Radu Fleaca specializes in arthroscopic surgery, knee surgery, sport and trauma surgery. Dr Fleaca has published more than 100 scientific articles, specialty books, he has more than 50 scientific presentations at national and international meetings to his credit. He is a member of the SOROT (Societatea Romana de Ortopedie si Traumatologie), SRATS (Societatea Romana de Artroscopie si Traumatologie Sportiva), SRCUC (Societatea Romana de Chirurgia Umarului si Cotului), ESSKA (European Society of Sports Traumatology, Knee Surgery and Arthroscopy), EKA (European Knee Associates) and AO Trauma.

Fixation Stability in Open Wedge High Tibial Osteotomy

Radu Fleaca, Mihai Roman, Bogdan Bocea, Ion Nicolas, Mohor Cosmin

“Lucian Blaga” University of Sibiu

Open Wedge High Tibial Osteotomy is a procedure that improves the biomechanics of the knee in patients with knee osteoarthritis. This procedure address young, active patients with symptomatic early knee osteoarthritis, with aim to decrease pain, increase function and delay knee replacement procedures.

Important complications of this procedure are related to non-union of the osteotomy gap. The healing of the osteotomy cut is significant related to the device used for fixation and also to operative technical aspects. In present modern surgery fixation is provided with plates. There are different designs and concepts for plates. This paper presents different plate designs and biomechanical considerations of fixation together with procedure related complications and outcome.

Some of the most important stability aspects are direct implant related, like the length of the plate, screw stability, screw length, but there are also procedure related factors, like the degree of the gap opening, grafting, hinge stability, loading, etc.

Literature data suggest that long locking plates provides the best fixation, even in important gap opening.

Horatiu Moldovan

Professor of Cardiovascular Surgery – “Carol Davila” University of Medicine and Pharmacy, PhD Habil, PhD and residents coordinator, Associate Professor at the Polytechnic University of Bucharest – Faculty of Materials Science and Engineering, Head of Cardiovascular Surgery Department and coordinator of the Heart Transplant Program at the Clinical Hospital Emergency Bucharest, coordinator of the Clinical Department of Pediatric Cardiac Surgery within the Emergency Clinical Hospital for Children “Grigore Alexandrescu”.

He is part of the group of specialists who introduced coronary surgery and aortic dissection surgery in Romania, as well as the implantation of the first mechanical assistance devices of circulation: intraaortic balloon pump, partial artificial heart type “Novacor” and more recently HeartMate 3; within all cardiovascular surgery departments he worked in, implemented new technologies related to minimally invasive cardiac surgery, endovascular surgery (EVAR, TEVAR) and transcateter valve prosthesis (TA).

Full Member of the Academy of Medical Sciences, an Associate Member of the Romanian Academy of Scientists, a Fellow of the American College of Cardiology, Full Member of the European Association for Cardio-Thoracic Surgery and member of the Board of the Romanian Society of Cardiovascular Surgery, as well as member of 10 other national and international scientific societies.

Published as main author 7 specialized books, participated with chapters in other 20 books and manuals, out of which 4 in prestigious international publishers. He is the author / co-author for a number of over 120 published scientific papers: 60 ISI indexed publications, 34 ISI indexed extenso articles, of which 24 as lead author, FCIAP 41, Hirsch Index 10; Key note speaker in over 200 scientific national and international scientific events.

Areas of excellence for his practice and publications are major vascular surgery – aortic, minimally invasive cardiac surgery, science and engineering of biomaterials as haemostatic agents and surgical adhesives, cardiovascular devices (valve and vascular prostheses), endovascular surgery and cardiostructural procedures, and mechanical ventricular assistance and transplantation.

Prof.Dr. Horațiu Moldovan

Left Ventricular Assist Devices in End Stage Heart Failure – Constructive Solution in XXI Century

Horatiu Moldovan

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

From the first heart surgery performed for a superficial wound of the ventricular wall to the cutting-edge technology of stem-cell cardiac regeneration, medical experts have been developing new techniques and technologies to improve or replace cardiac function. This article is a testimony of a small step for the grand array of cardiac bridge-therapy and transplant centres, but a beginning that was demanded in a country with a long waiting list of patients eligible either for transplant, or implant of ventricular assist device and only one qualified centre.

Heart assisting devices have been developing from the late 1960s and had and still have many issues to deal with: infectious potential of the life line, anticoagulation/antiplatelet therapy, immunosuppressive protocol, renal impact, neurological impact, the best implantation technique and the best device appropriate for the patient. These technological wonders were first thought as bridge-therapy for transplant, but now they are end-therapy for some end-stage heart failure patients or support for candidates for myocardial recovery.

Keywords: left ventricular assist devices, end stage heart failure.

Julietta V. Rau

Julietta V. Rau (Dr., PhD, Prof.) is currently Associated Research Director, Head of the laboratory and research group at the Institute of the Structure of Matter of the Italian National Research Council (ISM-CNR, Rome, Italy) and Professor at Sechenov First Moscow State Medical University (Moscow, Russia). She presented about 40 Invited, Plenary and Keynote talks at International Conferences. She received several international awards for her research achievements. She published about 200 papers in international high rank peer review journals, her present H-index is 35 (i10-index is 111, Citations > 4150 (Google Scholar)).

She is the CHAIR and organizer of the biennial BioMaH “Biomaterials for Healthcare” International Conference (https://biomah.ism.cnr.it) and the Member of the International Scientific Committees of various International Conferences in the field of Materials Science, Nanoscience, Biomaterials and Medical devices.

She is Associate Editor of “Bioactive Materials” (KeAi) journal, Associate Editor Fronties in Biomaterials Science “Bio-interactions and Bio-compatibility”, Associate Editor “In Vitro Models” (Springer) and Editorial Board Member of FRONTIES in Bioengineering and Biotechnology, Springer Nature Scientific Reports, Coatings, Journal of Advanced Drug Delivery Research, Drug Design Development & Therapy, EC Orthopaedics, The Open Biomedical Engineering Journal.

Her present research interests regard innovative biomaterials for regenerative medicine, among them calcium phosphates and glass-ceramics based materials for tissue engineering applications, possessing antimicrobial characteristics. Her recent publications are dedicated to bioactive nanostructured coatings of innovative composition for orthopaedic and dental implant applications and cements for bones, cranial-facial surgery and dentistry applications. She is also involved in research projects dedicated to Raman spectroscopy applications in medicine and the development of novel imaging approaches for cancer diagnostics.

Ion-doped calcium phosphate-based coatings with antibacterial properties for biomedical implants

Julietta V. Rau

Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR),

Via del Fosso del Cavaliere, 100 – 00133 Rome, Italy

In the nearest future, a significantly increased request for biomedical implants is expected due to ageing of population and rising of the life expectancy. Nowadays, the main requests for implants are their good osteo-integration and stability at a long term, accompanied by host bone regeneration process. With this aim, metallic implants are coated with biomimetic ceramic biomaterials substantially improving the properties of metals, creating a proper bone-material interface, and, as a result, leading to a better integration into the surrounding bone tissue. In the present investigation, the recent results obtained for coatings on titanium and on biodegradable metal alloy implants will be reported. Ion-doped calcium phosphate (CP) coatings have been extensively studied as promising materials for biomedical implants due to their ability to enhance biocompatibility, osteo-conductivity, and bone formation. A comprehensive analysis of the current state of the art in ion-doped CP-based coatings for orthopaedic and dental implant applications will be provided [1]. The effects of ion addition on the physicochemical, mechanical, and biological properties of CP coatings will be evaluated. The contribution and additional effects (in a separate or a synergistic way) of different components used together with ion-doped CP for advanced composite coatings will be identified. In the final part, the effects of antibacterial coatings on specific bacteria strains will be reported. The future perspectives will be discussed. The nanostructured materials developed in this work are promising for new antimicrobial strategies, ensuring required structural, chemical, morphological and mechanical characteristics and providing a controlled release of active principles, improving long term stability and performances of dental and orthopaedic medical implant devices.

The present investigation could be of interest to researchers, clinicians, and industry professionals involved in the development and application of CP coatings for orthopaedic and dental implants.

[1] Marco Fosca, Alexandru Streza, Iulian V. Antoniac, Gianluca Vadalà, and Julietta V. Rau. Ion-doped calcium phosphate based coatings with antibacterial properties. Review. /J. Function. Biomat. MDPI, 2023, v. 15, issue 5, p. 250 (45 pages) https://doi.org/10.3390/jfb14050250

Ilaria Cacciotti

Prof. Dr. Ilaria Cacciotti is Full Professor of Biomaterials & Tissue Engineering and Materials Science and Technology at University of Rome “Niccolò Cusano”, with consolidated expertise in the synthesis and characterization of (bio)materials and eco-sustainable systems. She is Member of the Research and Projects Committee and Erasmus+ Coordinator for Engineering Area. She graduated in Medical Engineering at the University of Rome “Tor Vergata” (Master of Science Award ‘Fondazione Raeli’). Afterwards, she completed the Ph.D in Materials Engineering (Ph.D Thesis Award ‘Marco Ramoni 2011, Ph.D Thesis AIMAT Award 2012) and she obtained the II Level Master degrees in “Forensic Genetics” and in “Protection against CBRNe events”. She is expert in the synthesis, processing and characterisation of biocompatible nanostructured materials, particularly for applications in the biomedical, environmental and agri-food sectors, including bioceramics (undoped and doped calcium phosphates, bioactive glasses), biopolymers and composites.

She is reviewer for more than 100 peer-review journals, e.g. Acta Biomaterialia, Biofabrication, Chemical Engineering Journal, has been/is Guest Editor of several Special issues, and is a member of the Editorial Board of several international journals, including Applied Science-MDPI, Applied Surface Science AdvancesElsevier, Biomedical glasses-DE GRUYTER OPEN, Frontiers in Biomaterials, Open Journal of Materials Science-Bentham Science, Recent Patents on Materials Science-Bentham Science, The Open Materials Science Journal-Bentham Open, Reviews on Advanced Materials Science-DE GRUYTER OPEN, and serves on various grant review committees, such as National Science Foundation (NSF), Canada Foundation for Innovation (CFI) and National Science Center (NCN, NARODOWE CENTRUM NAUKI). For her research activity, she was awarded with: 8th CCT Award “Best Oral Presentation for Young Researchers 2011”, 10th International Award “Giuseppe Sciacca” for Young Students, the European Biomaterials and Tissue Engineering Doctoral Award (EDA-ESB (European Society of Biomaterials)) Award 2011, “Top Cited Author 2011-2012 ChemEngJ”, “L’ORÉAL-UNESCO Italy for Women and Science 2011”, “Under 35 Talents in Lazio 2012”, “Featured Articles and Cover Pages for the following International Journals Chem Eng J, Nanotechnology, Advanced Materials Interfaces”, ”Young Researcher Award Elsevier” Materials Science and Engineering C” 2014, “Good Energy Award 2016”, “SRB Excellence Award 2018”, “Best Poster Award for 18th International Conference ”Life Sciences for Sustainable Development” 2019”, “BIOREMED Excellence Award 2019”, “Polymers 2020 Outstanding Reviewer Award”, “IOP trusted reviewer 2021”, “Inspirational Scientist Award in the International Scientist Award on Engineering, Science, and Medicine 2021”, “Women Researcher Award” in the International Scientist Awards on Engineering, Science and Medicine 2021”.

Custom mad approach by additive manufacturing for maxillofacial applications

Ilaria Cacciotti

Engineering Department, University of Rome “Niccolò Cusano”, via Don Carlo Gnocchi 3 00166 Rome, Italy, ilaria.cacciotti@unicusano.it

The global healthcare additive manufacturing market size is continuously and progressively growing. It was valued at USD 1,942.21 million in 2022, and is estimated to reach USD 7,504.49 million by the year 2029, with a Compounded Annual Growth Rate (CAGR) of 21.3% [Global Healthcare Additive Manufacturing Market Growth, Share, Size, Trends and Forecast (2023 – 2029)]. In particular, five main biomedical applications have bene highlighted for the 3D printing by Tuomi et al. [2014]: surgical guides, medical prototypes for the pre-surgery training [Saceleanu et al., 2021], surgical implants, external aids, and bio-manufacturing. The AM approach is characterized by several advantages, allowing to obtain complex geometries, using low cost technologies and drastically reducing the waste of materials, and to produce custom made devices and structures, including dental, orthopedic and craniomaxillofacial implants. The AM strategy consents to significantly decrease the surgery times, reduce blood loss and morbidity at the graft site, to contain and avoid the induction of infections/inflammations, to achieve a greater patient satisfaction due to better aestethical results [Al-Moraissi et al., 2015]. Moreover, the progressively increased interest towards the AM technologies in the biomedical field, mainly, in the craniomaxillofacial one, is testified by the enhanced number of publications focused on 3D printed implants, prostheses, scaffolds, and biomedical devices [Murtezani et al., 2022; Torsello et al., 2022]. However, despite the numerous promising achievements and the increasing demand for customized medical products, many efforts are requested and needed to bring the AM “from bench to bedside” [Di Piazza et al., 2021]. In this framework, the design, optimization, realization and proper functionalisation of 3D printed scaffolds and systems for the craniomaxillofacial and neurosurgery fields are reported, including cranial implants, fixation miniplates and scaffolds for regenerative medicine.

Acknowledgements The Author acknowledges the project POR FESR 2014–2020 ‘Gruppi di Ricerca’, titled ‘Sistemi Innovativi sensorizzati mediante Manifattura Additiva per la Cranioplastica” (SISMAC), financed by Lazio Region.

References

Al-Moraissi, E. A., El-Sharkawy, T. M., Mounair, R. M., & El-Ghareeb, T. I. (2015). A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. International journal of oral and maxillofacial surgery, 44(4), 470-482.

Di Piazza, E., Pandolfi, E., Cacciotti, I., Del Fattore, A., Tozzi, A. E., Secinaro, A., & Borro, L.(2021). Bioprinting technology in skin, heart, pancreas and cartilage tissues: Progress and challenges in clinical practice. International Journal of Environmental Research and PublicHealth, 18(20), 10806.

Murtezani, I., Sharma, N., & Thieringer, F. M. (2022). Medical 3D Printing with a focus on Point-of-Care in Cranio-and Maxillofacial Surgery. A systematic review of literature. Annals of 3D Printed Medicine, 100059. Saceleanu, V., Paz, R., García, J., Rivero, Y., Cîndea, C. N., Cacciotti, I., & Monzón, M. (2021). Production of Synthetic Models for Neuro-Oncology Training by Additive Manufacturing. Applied Sciences, 11(24), 11823.

Torsello, M., Salvati, A., Borro, L., Meucci, D., Tropiano, M. L., Cialente, F., … Cacciotti I. & Trozzi, M. (2022). 3D bioprinting in airway reconstructive surgery: A pilot study. International Journal of Pediatric Otorhinolaryngology, 161, 111253.

Tuomi, J., Paloheimo, K. S., Vehviläinen, J., Björkstrand, R., Salmi, M., Huotilainen, E., … & Mäkitie, A. A. (2014). A novel classification and online platform for planning and documentation of medical applications of additive manufacturing. Surgical innovation, 21(6), 553-559

Alexandru-Vlad Ciurea

Professor of neurosurgery, Senior neurosurgeon, Founder of the National Center for Excellency in Neurosurgery, Honorary President of the Romanian Society of Neurosurgery, Vice-President of the WFNS Nomminating Committee.

Current Status: Head of Neurosurgery and Scientific Director, “Sanador Medical Center” Hospital, Bucharest; Professor of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, Bucharest (1997-2022); Head & Chairman Neurosurgical Clinic 1, “Bagdasar-Arseni” Hospital, Bucharest.

Professional Affiliations:

Journal Neurosurgery (USA), International Advisory Board (2014); Journal World Neurosurgery (USA), Senior Advisors Pannel; Official Invited Lecturer, WFNS Continuous Medical Belem, Para, Brazil; Reelected Vicepresident of Euroacademia Multidisciplinaria Neurotraumatologica (December, Ulm, Germania); Member of Nominating Committee WFNS (Seoul, Korea); Official Member of Education Committee WFNS (Seoul, Korea); Honorary member of the Italian Society for Neurosurgery (Palermo, Italy); Vicepresident of Euroacademia Multidisciplinaria Neurotraumatologica; Vicepresident Romanian Medical Association; Honorary member of the Bulgarian Society for Neurosurgery; Member of the Romanian Academy of Medical Sciences; Chairman WFNS Nominating Committee (Boston, USA); Vice-President Academia Multidisciplinaria Neurotraumatologica (Cluj-Napoca, Romania); International Member of the Brazilian Academy of Neurosurgery; Member of the Romanian Academy of Scientists; Vice-President ”at large” of the World Federation of Neurosurgical Societies, Morocco; President, The Society of Neuro-Oncology, Romania.

Publications:

Main author of 33 monographs in neurosurgery, neurology, healthcare management and food research; Author to 40 ISI-indexed papers.

Honours, awards and distinctions: Nominated in the International Advisory Board of Neurosurgery (USA); Visiting Professor – International Neuroscience Institute – Hannover, Germany; Honorary Member of the Italian Society of Neurosurgery; Award of Excellence “Medica Academica” for Lifetime Achievement; Excellency Diploma of the Romanian Medical Association for the “Textbook of Neurosurgery” treatise, vol I and II; Excellency Diploma “Neurovasc” awarded at the International Congress of Cerebrovascular Surgery, Mumbai, India; Honorary Diploma of the Society for the Study of Neuroprotection and Neurorehabilitation (SSNN); Awarded prize for “Innovation in medical teaching” at the National “Healthcare Gala”; Diploma et charta aureus (full member) of the Romanian Academy of Scientists; Diploma of Excellency for Scientific Activity and Publishing in the Bucharest University of Medicine and Pharmacy, granted by the Journal of Medicine and Life, Bucharest; “New ideas regarding the presence of hidden anatomy in Michelangelo’s paintings”, registered with State Office for Inventions an Trademarks, Romania; Inventor’s license for “the unishunt drainage system”, single tube neurosurgical drainage system; an invention widely used in the World for the treatment of hydrocephalus; The National Order for Faithful Service of Romania with the rank of Commodore; a distinction awarded by the President of Romania.

4 Titles of Doctor Honoris Causa (Dunarea de Jos University, School of Medicine, Galați, Romania; N. Testemițanu University School of Medicine, Chisinau, Rep. of Moldova; Petre Andrei University, Iași, Romania; University of Oradea, School of Medicine, Oradea, Romania).

Actual Status of Biomaterials in Romanian Neurosurgery

Alexandru Vlad Ciurea ^1,2,3, Vicentiu Mircea Saceleanu^4,5, Bogdan Gabriel Bratu^6*, Andrei Adrian Popa⁶, Aurel-George Mohan^7,8,9

Professor of Neurosurgery and Emeritus Professor, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania;
Honnorary Member of the Romanian Academy, Medical Science Section, Romania;
Chief of the Neurosurgery Department and Scientific Director, Sanador Medical Center, Bucharest, Romania;
Associate Professor of Neurosurgery at “Lucian Blaga” University of Medicine, Sibiu, Romania
Chief of Neurosurgery Department, Sibiu County Emergency Hospital, Sibiu, Romania
Medical Student at “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania;
Professor Habil of Neurosurgery at Oradea Faculty of Medicine, Oradea, Romania;
Chief of Neurosurgery Department at Bihor County Emergency Hospital, Oradea, Romania;
Secretary of State, Ministry of Health, Bucharest, Romania;

Corresponding author: *Bogdan Gabriel Bratu bogdan.bratu@stud.umfcd.ro

INTRODUCTION: The usage of Biomaterials in Neurosurgery is an emerging topic, due to multiple applications and great results in long-term follow-up of patients, due to a better understanding of nanoparticles functions and structures, a wide array of biomaterials can be used with application both in cranial neurosurgery and in spinal neurosurgery. This paper will focus on the usage of biomaterials in cranio-cerebral traumatology, specifically cranioplasty and duraplasty, applications in hemorrhagic status and modalities of vascular neurosurgical treatment.

CONTENT: In nowadays scientific literature, there are four known types of grafts for cranioplasty: autogenic grafts (the same bone is reused, such as bone from cranium, ribs, shinbones, shoulder blades, sternum or ilia), allogenic grafts (the graft originates from another human, such as cartilage), xenogenic grafts (grafts transplanted from animals ex: bovines, pigs, etc.) and alloplastic grafts (graft consisting of inorganic material, such as celluloid, Polymethylmethacrylate-PMMA, polyetheretherketone-PEEK, hydroxyapatite, polyethylene, silicone, ceramic and other derivatives as metallic implants especially Aluminium, Gold, Silver, Lead, Platinum, Titanium, Tantalum and their alloys). Modern technology enables neurosurgeons to understand the three-dimensional anatomy of the skull and defect and allows them to be able to create implants perfectly tailored to the size and shape of the defect without neglecting the volumetry of the skull. The best materials of today appear to be PEEK due to their excellent mechanical properties’ other properties like non-immunogenicity, non-oncogenicity, sterility, biological tolerance and an acceptable price range.

Duraplasty is a common neurosurgical intervention, dural substitutes are used frequently to ensure dural closure in multiple cranial procedures. Synthetic grafts are manufactured indefinitely with high qualities, being more preferred in intracranial tumoral resection and for supratentorial or parasellar defects than biological grafts. Subsequently, allografts have the greatest results in Chiari malformation cases, while nonautologous duraplasty has a low complications rate down to 10.61%.

Important progresses in neurovascular area using modern biomaterials were registered, from different approaches of the complex intracranial aneurysm, to a more specific management of hemorrhagic state. Neurosurgical hemostatic biomaterials include Surgicel, Gelaspon, Fibrin glue and Fluosol-DA. Topical and externally administered hemostatic biomaterials from natural sources can be based on: cotton and cellulose, collagen (Avitene, Helistat), composite spray, gelatin (GelFoam, FloSeal), aliginate (Algosteril), chitosan (TraumaStat, HemCon), zeolite and kaolin powder (QuikClot, WoundStat), and blood-derived or recombinant hemostatic factors.

For intracranial aneurysm, biomaterials can be used in both the open surgery approach using clips and intravascular embolization with variants of coils. In open vascular neurosurgery, modern clips are represented by McFadden VariAngle, Sundt Slim-Line, Sugita and last but not least, the well-known Yasargil clips. While for the endovascular approach, embolic agents as well as coils systems are useful due to prothrombotic action. For the neurovascular field, stent systems and intrasaccular devices are worth to mention.

CONCLUSIONS: Currently, daily-use biomaterials in neurosurgery include devices used for endovascular procedures such as coils, stents, flow-diverters, endovascular cements, microsurgical clips. In skull deformities, biomaterials represent a tremendous leap forward in the surgical management, including bioabsorbable scaffolds for the regeneration of bone defects or dura mater with 3D-printed implants. Moreover, in spinal neurosurgery, biomaterials are used for stabilization and reconstruction devices (rods, screws, cages). Biomaterials are of unlimitted usage in surgical specialties.

KEYWORDS: Biomaterials, Vivostat, Cranioplasty, Duraplasty, Coiling, Clips;

Norina Forna

NORINA FORNA – is a university professor, Discipline “Clinic and therapy of partial extended edentation”, The Faculty of Dental Medicine within « Gr.T .Popa » University of Medicine and Pharmacy – Iaşi and an Primary care physician – Dental prosthetics at Policlinica Stomatologică no. 1 (Boltă). Former Dean of the Faculty of Dental Medicine, Vice-president of the College of Dental Practitioners in Romania ( 2015-2019; 2019-2023), President of the College of Dental Practitioners, Iasi(2015-2019; 2019-2023), Member of the National Council for Scientific Research – CNCS. Director of the Clinical Education Facility of the Faculty of Dental Medicine, Expert ANMCS- 2017, Expert CNATDCU – Comisia Medicina Dentara, President of the Romanian Dental Association for Education, President of the Romanian Society of Oral Rehabilitation, President of the Society of Regularized Computed Tomography, President of the Association of Dental Medicine, Iasi, Member in the Federal Bureau of the International Federation of Odontostomatology and Craniofacial Surgery, Member in the Managing Board of IMAT – Germany, Member in the Managing Board of EIDAM – Canada. Appointment of Dean assessor – ’Université des Montagnes, Cameroon, Vice-president of the College of Dental Practitioners Romania, president of the College of Dental Practitioners, Iasi, Medical Expert for Public health, Iasi, for the specialization General Dentistry (since 2005), President of the Dentistry Department within the Society of Doctors and Naturalists (since 2007), President of the Commission for the elaboration of practice guides in the field of dental prosthetics, CMDR (since 2007), Member in the Aracis medical commission.

Expert evaluator CNCSIS (since 2004), Expert evaluator ARACIS (2007). Evaluations: Member of Specialty Commissions of C.N.A.T.D.C.U. for the confirmation of the title Doctor in Medical Sciences and quality of by I.O.S.U.D, according to O.M.Ed. no. 3904/10.05.2006 (since 2006), Member of the Medical – Dental Specialty Commission within Consulting Commissions of the Health Ministry, according to order 466/2006, Member in the Commission of Ethics and Medical Deontology – The College of Dentists, Iasi, Expert evaluator National Research-Development Programs: Ideas and partnerships (2007 – present), Expert evaluator of CEEX, VIASAN programs, within the Academy of Medical Sciences (2008), Trainer in the field ,,Prevention and management of malpractice situations” (2011), Coordinator of the Specialization of Dental Prosthetics and Implantology, the Ministry of Health, Iasi University center (coordination of over 50 resident doctors in the specialization Dental prosthetics). INTERNATIONAL TITLES AND POSITIONS: President CIDCDF- Confederation of Deans of Faculties of Dental Medicine of Total or Partial French Origin, Past President European Proshtodontic Association, President of the Balkan Society of Dental Medicine (BaSS), Member in ERO FDI WG – RELATION BETWEEN DENTAL PRACTITIONERS AND UNIVERSITIES, Member in FDI WG Women Dentists Worldwide, President of the International Society of General and Oromaxillofacial Rehabiliation, Forum Odontologicum, Lausanne, Switzerland (2013) – present, Member in AFNOR-ISO, Expert ADEE, Fellow Global Dental Implant Academy – 2018, Fellow & Diplomat of International College of Dentistry (2013) – present, Fellow of Academy of Dentistry International (2013) – present, Member of the Administration Council of the Confederation of Deans of Faculties of Total or Partial French Origin (CIDCDF), Scientific Commission, since 2009- present, Member of the Council of the European Association of Dental prosthetics (2013) – present, European Specialist in Dental prosthetics – the European Prosthetics Association (EPA) since 2012- present, Ambassador Circle International Congress of Oral Implantologists (ICOI, SUA)- 2010 – 2012, 2012 – 2014, 2014-2015, 2015-2016, Fellow International Honor Dental Organization (2011) – present, Chevalier dans l`Ordre des Palmes Academiques, through decree since 1 March 2011- present, Expert AUF (L’Agence universitaire de la Francophonie) – 2011- present, Fellow and Diplomate al International Congress of Implantologists (2009) – present, Ambassador of the Confederation of Deans of Faculties of Total or Partial French Origin (CIDCDF) – 2008 – present, Member of European Society of Cosmetic Dentistry, since 2008- present, Member of the European Prosthetics Association (EPA), since 2007- present, Member in the Managing Board IMAT, Germany (2006) – present, Member in the Managing Board Eidam, Canada (2006) – present, Vice-president of the International Congress of Oral Implantologists – for Romania (ICOI, SUA) 2011- present, Ambassador for Romania of the Federal Bureau of Odontodentistry and Craniofacial Surgery (I.F.O.S.C.M.F.S.) 2008

Practical applications regarding the use of bone regeneration materials in resorptions and bone substance losses

Norina Forna 1, Agop-Forna Doriana 1

1 Grigore T. Popa University of Medicine and Pharmacy, 16 Univesității, Iași, Romania, profforna@gmail.com

Introduction. Intraoral bone loss and resorption pose significant challenges in dental and maxillofacial surgery, requiring effective management strategies for successful bone regeneration. This study aims to discuss the practical applications and clinical considerations surrounding the use of intraoral bone regeneration materials in the context of bone loss and resorption.

Experimental. A comprehensive review of the scientific literature was conducted to gather evidence regarding the practical applications of intraoral bone regeneration materials. The review encompassed studies evaluating various types of grafting materials, including autogenous bone grafts, allografts, xenografts, and synthetic bone substitutes. The clinical outcomes, surgical techniques, and rehabilitation possibilities were assessed, considering factors such as defect size, location, and patient-specific considerations.

Results and Discussion. The research revealed that the selection of appropriate intraoral bone regeneration materials depends on multiple factors, including the volume and quality of available bone, the type and extent of the defect, and the desired clinical outcome. Autogenous bone grafts demonstrated superior outcomes, while allografts, xenografts, and synthetic bone substitutes provided alternative options with advantages such as reduced morbidity and improved handling characteristics. Surgical techniques, guided bone regeneration and socket preservation, were found to enhance the success of bone regeneration procedures. The rehabilitation possibilities include dental implant placement, prosthetic rehabilitation, and restoration of oral function.

Conclusions. Intraoral bone regeneration materials offer practical solutions for managing bone loss and resorption in dental and maxillofacial surgery. The choice of grafting material should be tailored to the individual patient and specific clinical scenario, considering factors such as defect size, location, and patient preferences. The use of appropriate surgical techniques, combined with comprehensive rehabilitation strategies, facilitates successful outcomes in restoring oral health and function. Further research is needed to optimize the selection, integration, and long-term performance of intraoral bone regeneration materials.

Keywords: Bone resorption, grafting materials, practical applications, clinical considerations.

References.

[1] Jensen SS, Broggini N, Hjørting-Hansen E, et al. Bone regeneration and tissue integration of dental implants in the augmented jaw: a preclinical study. Int J Oral Maxillofac Implants. 2006;21(6):875-885.

[2] Urban IA, Monje A, Lozada JL, et al. Vertical ridge augmentation with a collagen membrane and a combination of particulate autogenous bone and inorganic bovine bone-derived mineral: a prospective case series in 25 patients. Int J Periodontics Restorative Dent. 2013;33(3):299-307.

[3] Araújo MG, Sukekava F, Wennström JL, Lindhe J. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol. 2005;32(6):645-652.

Cosmin Sinescu

Cosmin Sinescu (40 years old) is full professor at the Victor Babeş” University of Medicine and Pharmacy Timişoara, Faculty of Dentistry, Prostheses Technology and Dental Materials Department. The Habilitation Thesis (2015) was focused on new methods of diagnostic and forecast in dentistry. His main research interests and competences include invasive and noninvasive, destructive and nondestructive methods of investigations in dentistry, dental materials, bioengineering, biocompatibility, optoelectronics, imagistic investigations in dentistry – optical coherence tomography, management of scientific research projects in medicine and pharmacy; principles and applications of optical coherence tomography; modern optical testing – field guide to interferometric optical testing; structural adhesives for optical bonding; principles of diffraction, interferometry, holography and difractive optical elements, synchrotron investigation. He was part of the research group that developed the first Time Domain Optical Coherence Tomography and the first Spectral Domain Optical Coherence Tomography Systems dedicated to dentistry in the east of Europe. Since 2005 he is a Visiting Senior Research Fellow in the Applied Optics Group at the University of Kent at Canterbury, UK. He is member in the research team of 14 grants – by 4 of them as project manager. He published many papers in ISI refereed journals and conference proceedings. The address of the researcherid.com profile is: http://www.researcherid.com/rid/G-1528-2011. He is a member of SRLS, SSB, SRB, IEEE, OSA and SPIE.

New trends in dental adhesives

Sinescu Cosmin^{1, 2}, Meda Lavinia Negrutiu^{1, 2}, Virgil Florin Duma^{2, 3, 4}, Mihai Rominu^{1, 2}, Emanuela Lidia Craciunescu, Carina Sonia Neagu^{1, 2}, Christa Serban, Florin Topala, George Dobre, Adrian Bradu⁵, Adrian Gh Podoleanu⁵

1 – School of Dental Medicine, Victor Babes University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300070 Timisoara, Romania;

2 – Research Center in Dental Medicine using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, Timisoara, Romania

3 -3OM Optomechatronics Group, Faculty of Engineering, Aurel Vlaicu University of Arad, Arad, Romania

4 Polytechnic University of Timisoara, Timisoara, Romania

5- Applied Optics Group, School of Physics, University of Kent, Canterbury, United Kingdom

Dental adhesives have a wide range of applications, including the placement of direct composite restorations on front and posterior teeth. One common issue leading to the failure of composite resin restorations is microleakage.

To address this problem, a new type of dental adhesive infused with magnetic nanoparticles (MPs) has been developed in the laboratory. The primary objective of this study is to produce adhesives with a minimized width/thickness to decrease the risk of microleakages.

To evaluate the adhesive layer’s width and thickness in different areas of the teeth, two investigative techniques were employed: optical microscopy, which is widely used but less precise, and the more accurate and volumetric micro-Computed Tomography (CT). For the experiment, twenty extracted teeth were divided into four groups. Group 1 consisted of blank’ samples with adhesive without MPs, while Group 2 included samples with adhesive doped with MPs. In Groups 3 and 4, the adhesive doped with MPs was exposed to an active magnetic field for 5 and 10 minutes, respectively. Microscopy, micro-CT, and EDAX investigations were performed on the adhesive samples.

While microscopy and micro-CT results showed good agreement, micro-CT offered a comprehensive volumetric reconstruction of the adhesive layer, enabling a thorough analysis of the adhesion of the four dental materials.

Mathematical models were developed using the micro-CT results, presenting the relationship between surface areas and adhesive layer width for each group. Additionally, the volume of sealants was analyzed. This methodology represents a novel approach in this field. The study also extracted characteristic parameters and discussed the optimal parameter for such assessments.

The findings of the study demonstrate improved adhesion in Groups 3 and 4, where MPs were incorporated into the adhesive. Furthermore, the study concludes that the adhesive material should be exposed to the magnetic field for the longest possible duration, considering the clinical treatment duration as well.

To prevent microleakage, dental adhesives were augmented with magnetic nanoparticles (MINs). These MINs reduced the thickness of the adhesive layer when applied in a magnetic field, thus minimizing microleakage. Furthermore, they enhanced bond strength by promoting adhesive penetration into dentinal tubules. However, the color of the restoration was affected by the presence of MINs. Thus, this study aimed to test the hypothesis that MN coating can mitigate the esthetic impact of magnetic dental adhesives.

The researchers synthesized MINs with different coatings: MINs with silica coating (MINTs-SiOn), calcium-based coating (MINTs-Ca), and no coating.The morphology of the MINs was examined using transmission electron microscopy (TEM) and scanning electron microscopy (SEM), while their chemical composition was analyzed using energy-dispersive X-ray spectroscopy (EDX). The magnetic properties of the MINs were measured using a vibrating sample magnetometer.

The study revealed that MINs-SiO had a globular morphology, whereas MNPs-Ca exhibited a cubic shape. The SiO layer had a thickness of 73.1 mm=99 rum, while the Ca(OH) layer measured 19.97 mm =2.27 rum. The saturation magnetization values were 18.6 emug for MPs-SiOs, 14.7 emu/g for MNPs-Ca, and 65.7 emu/g for uncoated MINs.

To assess the impact on color, occlusal cavities were prepared in 60 molar phantoms, divided into four groups, and restored using the same adhesive with varying MIN contents. Group 0 served as the control with no MPs, Group 1 contained MNs-SiO, Group 2 included MNPs-Ca, and Group 3 utilized uncoated MINs. The color of the restorations was quantified using a dental spectrophotometer in the CIELAB color space.

The results indicated that the color difference between Group 0 and Group 2 was close to the acceptability threshold of 50:50%. The whiteness index was similar for Groups 0, 1, and 2. These findings suggest that MN coating effectively mitigates the impact of magnetic dental adhesives on the color of restorations.

Vicentiu Saceleanu

Dr. Vicentiu Saceleanu M.D., Ph.D, Head of the Neurosurgery Departament, Sibiu; Assoc. Prof. , University Lucian Blaga Sibiu. He was born in 1968 in Sibiu – Romania, graduated from the Faculty of Medicine and Pharmacy „Iuliu Hațieganu„ Cluj-Napoca, Romania in 1994, received his Ph.D. from Lucian Blaga University (Sibiu-2011) and since 2011 he is the head of the Neurosurgical Department (County Hospital – Sibiu). Since 2000 he is a member of the Romanian Society of Neurosurgery, AOS International, Medical College of Sibiu and since 2016 he became a member of the Romanian Society of Biomaterials. He was a Associate Professor at Lucian Blaga University and since 2017 he joined the University of Sibiu as a full Professor, directing the Neurosurgical Department. In 2011 dr. Saceleanu founded the Neurosurgical Circle from Sibiu with 50 active students, participating in over 15 international and national congresses and coordinated over 20 presentations. Dr. Saceleanu is the author of 3 neurosurgical books, coauthor in 2 books and he published 194 articles in national and international journals.

SCIENTIFIC ACTIVITY: – Participation in numerous congresses and courses of Continuing Medical Education in Neurosurgery starting from 1995; participation in the national and international conferences as chairman and speaker: Romanian-German Courses of Neuro-traumatology; Sibiu Medical Days Conference, Chairman at Sibiu Medical Days 2011, 2013; International Seminar Paulo Freire “For a pedagy of the dialogue”; Stroke Conferences with international participation and symposia of Neurology and Psychiatry, Neurophysiology Electrodiagnostic Conference, Congresses and conferences on Neuroprotection and Neuroplasticity, Neurooncology Conference, Symposium “Il metodo Feuerstein”, National Symposium of corticosteroids, the Conferences of the Society of Surgery;

– Participation to specialized courses in the field of neurosurgery: Skull Base Surgery Course; Bucharest; Vertebroplasty course Bucharest;

– Participation to international course Hands on: ”Microsurgical and Endovascular Technoques”, decembrie 2018, Salzburg;

– Local coordinator of the International Grant: Comparison of Cerebrolysin and Standard Treatment;

– Coordinator of project Brain Revealed: Innovative Technologies in Neurosurgery Study –

2018-1-RO01-KA203-049317, 01.09.2018 – 31.08.2021;

– Patent: cranial implant with osseointegration stryctyres and functional coatings, international exhibition of scientific research, innovation and invention, 2018.

PUBLISHING ACTIVITY: – Editor of the book of Clinical Neurosurgery, 2014 ;

– 3 specialty book in Romanian language, 2014, 1 specialty book in English language, 2014,

– 194 articles.

RESEARCH ACTIVITY: – Professional training of residents (Neurology, Surgery, Orthopedics, Ophthalmology, Forensic Medicine), since 2011 till present;

– Founder and coordinator of the Neurosurgery Circle, LBUS, 2013,

– Development of Syllabus and course description of Neurosurgery discipline within the II Department of V. Papilian Faculty of Medicine Sibiu;

– Local organizer of 2 Neurosurgery Conferences, 2002, 2009 and one Conference of Neuro-rehabilitation at Ocna Sibiului, 2007;

– Organiser of Sibiu Medical Days, 2014;

– MAIN organizer of the Conference: “Treatment options and methods of rehabilitation in stroke and spinal pathology “, Sibiu, 2014, December 5.

– Member of the Scientific Commission of the County Clinical Emergency Hospital Sibiu, decision of Sibiu County Council no. 111/23.01.2015.

– Local main coordinator at the International Grant: Comparison of Cerebrolysin and Standard Treatment Evaluating the Neuroprotective and Neurorehabilitation Outcome in a Randomized, Double –Blind, Controlled Trial on Efficacy and Safety in Patients with Moderate to Severe Traumatic Brain Injury.2014, no.3455/27.02.2014

– Development of the research plan for the Neurosurgery discipline for the years 2012-2014 & 2014-2020 “V. Papilian” Faculty of Medicine Sibiu;

– Member of the Research Group of Ocular Surface, since 2014;

– Chairman of the Organizing Committee of the 45th edition of the Congress of the Romanian Society of Neurosurgery, Sibiu, October 2019;

– manager of the interntional project on Erasmsus Programme – Brain Revealed: Innovative Technologies in Neurosurgery Study – Universitatea Lucian Blaga din Sibiu;

Brain IT: From biomaterials to neurosurgery practice

Vicențiu Mircea Săceleanu

Lucian Blaga University of Sibiu, Romania

From an ethical point of view, the training of young residents and neurosurgeons on real patients remains a delicate challenge. For this reason, the technological advances in the current 3d printing sphere must be used to help in the practical training of young neurosurgeons. We dared to take a first step, simulating surgical interventions on 3D reconstructed skulls, with traumatic and tumoral pathologies.

The Brain IT Project represents an interdisciplinary collaboration between biomaterials and neurosurgery with the ultimate goal of creating 3D models of the skull and cranial pathologies and simulating operations in a real way, with dimensions and repetitions identical to the real patient.

This method can also be used by senior neurosurgeons, when it comes to a more difficult case, which involves significant operative risks, and on which the simulated intervention could be simulated several times, before the examination with the real patient.

During three intensive summer schools, the project tried to include a wide range of neurosurgical pathologies with the aim of exposing both students and medical staff to some of the challenges that neurosurgery has due to its complexity. So that, both through theoretical support and especially through practical support, the students had the opportunity to immerse themselves in traumatic, tumoral and neurovascular neurosurgical pathology.

From our experience, the materials used in the reproduction of bone tissue were quite easy to achieve, after a few tests. The big challenge was to find materials similar to the brain parenchyma and intracranial soft tissues, whose printing is much more difficult.

Future advances in medical bioengineering will facilitate an easier approach to the brain through molds and devices that simulate various neurosurgical approaches, creating new opportunities in developing the practical skills needed to study the brain.

In our opinion, training in well-equipped simulation centers is the future for training in surgery, being a lower-cost option, with reduced ecological impact and that avoids medical ethics problems. Laboratory animals and cadaver specimens are often difficult to access to small surgical centers.

Gabriel Gruionu

Dr. Gabriel Gruionu is a versatile professional with a strong scientific background, excelling as a researcher, inventor, entrepreneur, and technology development specialist. Holding an MS Degree in Biomedical Sciences from The University of Missouri-Columbia and a Ph.D. Degree in Biomedical Engineering from the University of Arizona, he further refined his expertise through post-doctoral studies at the Indiana University School of Medicine and Harvard Medical School. Dr. Gruionu’s substantial contributions span various domains, including extensive R&D experience in the medical product industry, collaboration with esteemed institutions and medical professionals, teaching medical device development courses, authoring peer-reviewed publications and book chapters, and involvement in awarded and pending medical device patents. He has also delivered numerous national and international presentations, secured research grants from prominent organizations, and currently serves as a Research Assistant Professor in the Division of Cardiology at the Indiana University School of Medicine, where he focuses on advancing computer-assisted surgical navigation and medical robotics in the field of cardiology. Additionally, he actively mentors and contributes to entrepreneurship programs and think tanks in the field of medical devices.

Predictive Computational Model for Intramyocardial Hemorrhage in Reperfused Myocardial Infarction

Gabriel Gruionu (ggruionu@iu.edu)

Affiliation: Krannert Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.

Abstract:

Acute Myocardial Infarction (MI) is a major cause of death in all countries, and while percutaneous coronary intervention (PCI) has reduced immediate MI-related deaths, it can lead to secondary myocardial injury, including hemorrhagic MIs associated with adverse outcomes. The underlying mechanisms of post-reperfusion hemorrhage remain unclear, and current clinical practices may contribute to overperfusion and subsequent myocardial hemorrhage due to hemodynamic factors. This study aimed to develop a predictive mathematical model of hemorrhagic myocardial infarction (hMI) and determine the optimal reperfusion pressure to prevent hemorrhage in patients with specific coronary circulation. Through analysis of contrast medium and X-ray angiography of patients with and without hemorrhage, the study examined vascular topology and blood distribution in the myocardium. A computational model using Matlab software was developed, incorporating boundary conditions, microvascular network fluid dynamics, conductance matrix, pressure gradient, flow rate computations, and data display. The model simulated pre- and post-PCI scenarios with and without collaterals, considering different reperfusion pressures to identify the optimum pressure to avoid hemorrhage. The study found that the coronary vascular network is complex, and simulations helped determine optimal procedure parameters before PCI. Collaterals were found to prevent underperfusion and overperfusion, and an optimized reperfusion pressure was derived to avoid capillary overperfusion and hemorrhage. This pilot study provides a theoretical framework and computational algorithms for understanding and predicting hMI, with potential application in real-time computation of patient-specific reperfusion pressures to prevent hMI in clinical practice.

Cătălin Popa

Dean, Faculty of Materials and Environmental Engineering; Head of Biomaterials Research Group; Technical University of Cluj-Napoca, ROMANIA.

Dr. Cătălin Popa is a Professor in the Department of Materials Science and Engineering, Dean of the Faculty of Materials and Environmental Engineering, Head of the Biomaterials Research Group in the Technical University of Cluj-Napoca (TUCN). He is an Engineer since 1986 and, after working as a design engineer in several companies, he has become a member of the academic staff of TUCN since 1990. From the very early stages of his career, he worked in the field of Biomaterials and, later, he created the Biomaterials Research Group. Doctor of Engineering since 1997, Professor Popa was awarded a NATO / Royal Society Fellowship in the University of Nottingham (2000). He was a recognized researcher in numerous research projects in the UK, in the IRC in Biomedical Materials, Queen Mary, University of London, and Rutherford Appleton Laboratory, STFC, as well as director in 29 research grants awarded by Romanian public funding bodies. The Biomaterials Research Group he leads focuses on optimisation of medical implants / devices, Tissue Engineering applications, drug delivery systems and Medical Microfluidics. Fundamental or developmental research for industry, in Romania, Germany or UK is, also, a key topic for the group he leads.

DRUG DELIVERY SYSTEMS IN INTEGRATED STRUCTURES

Professor Cătălin Popa, Technical University of Cluj – Napoca, Faculty of Materials and Environmental Engineering, Department of Materials Science and Engineering

Conventional drug delivery presents a series of problems, according to either the physical state or the route of administration of the drug: coalescence of oily droplets, sedimentation of powders, instability of dispersions on one hand and side effects of first – pass metabolism on the other. In time, for more effective treatments, the immediate release of drugs was replaced by delayed release or sustained release (with the risk of temporary exceeding the maximum admitted concentration). Our paper deals with the controlled releasing of drugs, by the means of microcarriers to be placed at the site of interest, that were designed per application to assure an extended continuous delivery curve, with a long asymptotic region at the end. By adopting application – tailored systems, designed in integrated structures, the stability, safety, effectiveness, and therapeutic profile of the drug could be optimized. The general manufacturing route starts with the preparation of BSA gel microcapsules, subsequently coated with multiple layers designed on application, then loaded with the drug by a personalized method. The resulted microcarriers were integrated in structures designed for the approached therapy. Several systems developed in The Biomaterials Research Group are presented: endosseous implants made of porous titanium loaded with microcarriers delivering growth factors to assist osseointegration and wound healing post – implantation; active wound dressings made out of chitosan films loaded with microcarriers for a controlled release of tetracycline; natural anti – cancer therapy by the means of controlled release of curcumin; optimized delivery of chemotherapeutics such as sorafenib and doxorubicin; in – ear controlled delivery of dexamethasone. In all cases, the biologic effect was assessed, proving and increased performance compared to conventional medical approaches.

Cristian Dinu

CRISTIAN DINU DMD, MD, MSc, PhD, Assoc. Professor, Consultant in Oral and Maxillofacial Surgery, Department of Maxillofacial Surgery and Implantology, University of Medicine and Pharmacy „Iuliu Hatieganu” Cluj-Napoca, Romania. Dean of the Faculty of Dental Medicine, University of Medicine and Pharmacy „Iuliu Hatieganu” Cluj-Napoca, Romania. Founder of Med Artis Dent – private Clinic with activity based on oral implantology, esthetic dentistry and periodontology. Master of Plastic Periodontal Surgery at University of Bologna (Director: Prof. Dr. Giovanni Zucchelli). Extensively lectures in several national and international congresses of Oral and Maxillofacial Surgery and Oral Implantology. More than 20 years of experience in advanced oral implantology. Research member and coordinator in 15 european and national scientific projects.Received several prizes in national and international scientific events. Author and co-author of more than 90 papers in national and international journals. Co-author of 8 speciality books. Specific focus in reconstructive microsurgery, plastic and reconstructive surgery, craniofacial trauma and malformations, salivary glands pathology and advanced oral implantology and periodontology. General Secretary of the Romanian Society of Oral and Maxillofacial Surgery, Member of European Association for Cranio-Maxillofacial Surgery, International Association of Oral and Maxillofacial Surgery, Arbeitsgruppe fur Ostheosynthesefragen AOCMF, International Team for Implantology, etc.

Maxillofacial Implants and their Clinical Performance

Cristian Dinu¹, Mihaela Băciuț¹, Simion Bran¹, Florin Onișor¹, Sergiu Văcăraș¹, Gabriel Armencea ¹, Ileana Mitre ¹, Sebastian Stoia¹, Tiberiu Tamaș¹, Daiana Opriș¹, Horia Opriș¹, Avram Manea¹, Grigore Băciuț¹

¹Iuliu Hatieganu University of Medicine and Pharmacy, Maxillofacial Surgery Clinic, Cluj-Napoca, Romania

Face represents identity. Any damage to this region will generate physical, functional and psychological problems. There are many pathologies such as trauma, tumors or malformations that will require a very precise rehabilitation. Virtual planning and 3D printing technologies are indispensable tools in oral and maxillofacial surgery. Custom implants are made using computer-aided design (CAD) using a virtual plan based on the patient’s 3D scan. All CAD-based individualized implant systems require preoperative computerized planning. The scan will be transferred to the planning software, where the unaffected side can be mirrored to match the affected one. From this moment, 3D models of the reconstructed skeleton can be obtained with the help of 3D printers. On these models, standardized plates, meshes or implants can be designed, bent and sterilized preoperatively together with the 3D model and can be used intraoperatively.

Virtual planning is used for the manufacture of patient-specific implants (PSI) through the process of selective laser melting. This method is currently considered the most accurate technique for skeletal reconstruction. PSI is not malleable and avoids human errors. This leads to a very precise implant that can be placed with maximum accuracy. These technologies are used for a very wide field of pathologies such as orbit reconstruction, orthognathic surgery, microsurgical reconstructions with free flaps, oral implantology, temporomandibular joint reconstruction and recently for facial transplantation and facial feminization surgery.