Design and properties of a new hybrid stent-graft device

This PhD work explored a novel bio-inspired approach for designing artificial blood vessel implants known as stent-grafts. The design was inspired from body design of a caterpillar. This design concept induced natural flexibility and expandability property in the new stent-graft, which is considered critical in deciding long-term health of treated patients.

A new design concept for knitted external vein-graft support mesh

Autologous vein-graft failure significantly limits the long-term efficacy of coronary artery bypass procedures. The major cause behind this complication is biomechanical mismatch between the vein and coronary artery. The implanted vein experiences a sudden increase (10-12 fold) in luminal pressures. The resulting vein over-distension or 'ballooning' initiates wall thickening phenomenon and ultimate occlusion. Therefore, a primary goal in improving the longevity of a coronary bypass procedure is to inhibit vein over-distension using mechanical constriction. The idea of using an external vein-graft support mesh has demonstrated sustained benefits and wide acceptance in experimental studies. Nitinol based knitted structures have offered more promising mechanical features than other mesh designs owing to their unique loosely looped construction. However, the conventional plain knit construction still exhibits limitations (radial compliance, deployment ease, flexibility, and bending stresses) which limit this design from proving its real clinical advantage. The new knitted mesh design presented in this study is based on the concept of composite knitting utilising high modulus (nitinol and polyester) and low modulus (polyurethane) material components. The experimental comparison of the new design with a plain knit design demonstrated significant improvement in biomechanical (compliance, flexibility, extensibility, viscoelasticity) and procedural (deployment limit) parameters. The results are indicative of the promising role of new mesh in restoring the lost compliance and pulsatility of vein-graft at high arterial pressures. This way it can assist in controlled vein-graft remodelling and stepwise restoration of vein mechanical homoeostasis. Also, improvement in deployment limit parameter offers more flexibility for a surgeon to use a wide range of vein diameters, which may otherwise be rendered unusable for a plain knit mesh.

The effect of polypropylene-graft-maleic anhydride on the morphology and dynamic mechanical properties of polypropylene/polystyrene blends

Polypropylene (PP) and polystyrene (PS) blends were prepared by melt processing in a haake at 180 °C. PP/PS blends are immiscible and the blend morphologies were characterized by scanning electron microscopy. The viscoelastic properties were characterized using dynamic mechanical analysis (DMA) with reference to blend ratio. The blend morphologies such as matrix droplet and phase inverted morphologies were observed. The storage modulus of the blends increased with increase in PS content and the value was maximum for neat PS. DMA showed changes in the polystyrene glass transition temperatures (Tg) over the entire composition range. There was a sharp increase in the Tg of PS with increasing PP content in the blend and a 12 °C elevation in Tg was observed. The increase in Tg was explained by proposing a new model based on the physical interaction between the blend components. It is assumed that the different effects by the PP phase resulted in the formation of constrained PS chains leading to high Tg values. The addition of PP-g-MAH has a positive effect on the morphology, increases the storage modulus, and decreases the Tg till 80/20 blends. However, for PP/PS blends with higher concentrations of PS, the PP-g-MAH has little effect or adverse effect on the morphology, and storage modulus, but decreases the Tg.

Psychosocial issues facilitating recovery post-CABG surgery

Background
The acute illness phase following coronary artery bypass graft (CABG) surgery is a difficult time for patients as they try to adjust to the physical and emotional changes brought about by surgery.
Aims
To conduct an indepth examination of psychosocial issues experienced by patients post-CABG surgery and how patients manage these psychosocial issues during their recovery.
Methods
A qualitative research approach, naturalistic inquiry, guided the study. Thirty patients were interviewed 4–5 weeks following discharge from hospital after CABG surgery and at 12 months after the initial interview.
Results
esults found that adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. Patients spoke of mental and emotional changes, and coming to terms with lifestyle adjustments.
Conclusion
Study findings suggest the need for a re-examination of hospital discharge preparation and further provision and monitoring of home support services.

Renal transplantation in patients with primary immunoglobulin A nephropathy

Background. Opinions on the clinical course and outcome of renal transplantation in patients with primary immunoglobulin A nephropathy (IgAN) have been controversial.
Methods. We conducted a retrospective single-centre study on 542 kidney transplant recipients over the period 1984–2001. Long-term outcome and factors affecting recurrence in recipients with primary IgAN were analysed.
Results. Seventy-five patients (13.8%) had biopsy-proven IgAN as the cause of renal failure, and their mean duration of follow-up after transplantation was 100 ± 5.8 months. Fourteen (18.7%) of the 75 patients had biopsy-proven recurrent IgAN, diagnosed at 67.7 ± 11 months after transplantation. The risk of recurrence was not associated with HLA DR4 or B35. Graft failure occurred in five (35.7%) of the 14 patients: three due to IgAN and two due to chronic rejection. Three (4.9%) of the 61 patients without recurrent IgAN had graft failure, all due to chronic rejection. Graft survival was similar between living-related and cadaveric/living-unrelated patients (12-year graft survival, 88 and 72%, respectively, P = 0.616). Renal allograft survival within the first 12 years was better in patients with primary IgAN compared with those with other primary diseases (80 vs 51%, P = 0.001). Thereafter, IgAN patients showed an inferior graft survival (74 vs 97% in non-IgAN patients, P = 0.001).
Conclusions. Our data suggested that around one-fifth of patients with primary IgAN developed recurrence by 5 years after transplantation. Recurrent IgA nephropathy in allografts runs an indolent course with favourable outcome in the first 12 years. However, the contribution of recurrent disease to graft loss becomes more significant on long-term follow up.

Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Objective:
To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting:
A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants:
14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results:
Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion:
This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Improvement in mechanical properties of aluminum polypropylene composite fiber

Aluminum particles (Al) were added to polypropylene (PP) in the presence of poly ethylene glycol (PEG) and polypropylene-graft-maleic anhydride to produce composites. The composites were then melt-spun into a mono filament and tested for tensile properties, diameter evenness and morphology. Melt rheological properties of Al/PP composites were studied in linear viscoelastic response regions. It was observed that level of dispersion of aluminum particles within a polypropylene composite fiber could be improved by incorporating polyethylene glycol. The improvement of dispersion led to an improvement in the fibers mechanical properties through a reduction of the coefficient of variation of fiber diameter.

Grafts in myringoplasty : utilizing a silk fibroin scaffold as a novel device

Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.

The case | Allograft dysfunction in a patient with sickle cell disease

The article focuses on the study concerning the diagnosis of acute renal allograft in patient with sickle cell disease. The 33 year old underwent several surgeries with immediate graft function. The percutaneous renal biopsy of the patient shows focal cortical necrosis and acute tubular damage coherent with ischemia. It concludes that the allograft sickling is the primary cause of the acute renal dysfunction in patients with sickle cell disease.

Preliminary results of the application of a silk fibroin scaffold to otology

The surgical treatment to repair chronic tympanic membrane perforations is myringoplasty. Although multiple autologous grafts, allografts, and synthetic graft materials have been used over the years, no single graft material is superior for repairing all perforation types. Recently, the remarkable properties of silk fibroin protein have been studied, with biomedical and tissue engineering applications in mind, across a number of medical and surgical disciplines. The present study examines the use of silk fibroin for its potential suitability as an alternative graft in myringoplasty surgery by investigating the growth and proliferation of human tympanic membrane keratinocytes on a silk fibroin scaffold in vitro. Light microscopy, immunofluorescent staining, and confocal imaging all reveal promising preliminary results. The biocompatibility, transparency, stability, high tensile strength, and biodegradability of fibroin make this biomaterial an attractive option to study for this utility.

pH-detachable polymer brushes formed using titanium−diol coordination chemistry and living radical polymerization (RAFT)

pH-detachable poly(styrene) brushes formed on indium−tin oxide (ITO) glass substrates using metal complex chemistry and reversible addition−fragmentation chain transfer (RAFT) polymerization was described. These pH-detachable polymeric brushes were generated using both “graft-from” and “graft-to” methodologies. The methodologies involved either the surface self-assembly of catechol-functional RAFT agents (graft-from) or catechol-terminal polymer chains (graft-to) onto the ITO substrate via titanium−diol coordination. The stepwise functionalization of the ITO glass surfaces was characterized successfully using X-ray photoelectron spectroscopy (XPS) and contact angle measurement. Poly(styrene) brushes generated using the “graft-from” method were denser than those generated using the “graft-to” method, as exemplified by atom force microscopy (AFM) and quantified using cyclic voltammetry. Poly(styrene) brushes assembled using both methods could be detached easily by manipulating the pH of the brush environment. Cyclic voltammetry was utilized to calculate precisely the surface coverage of the RAFT functionality and polymeric brush density.

Patient-reported outcomes following islet cell or pancreas transplantation (alone or after kidney) in type 1 diabetes: a systematic review

Aims For selected individuals with complex Type 1 diabetes, pancreatic islet transplantation (IT) offers the potential of excellent glycaemic controlwithout significant hypoglycaemia, balanced by the need for ongoing systemic immunosuppression. Increasingly, patient-reported outcomes (PROs) are considered alongside biomedical outcomes as a measure of transplant success. PROs in IT have not previously been compared directlywith the closest alternate treatment option, pancreas transplant alone (PTA) or pancreas after kidney (PAK).

Methods We used a Population, Intervention, Comparisons, Outcomes (PICO) strategy to search Scopus and screened 314 references for inclusion.

Results Twelve studies [including PRO assessment of PAK, PTA, islet-after kidney (IAK) and islet transplant alone (ITA); n = 7–205] used a total of nine specified and two unspecified PRO measures. Results were mixed but identified some benefits which remained apparent up to 36 months post-transplant, including improvements in fear of hypoglycaemia, as well as some aspects of diabetes-specific quality of life (QoL) and general health status. Negative outcomes included short-term pain associated with the procedure, immunosuppressant side effects and depressed mood associated with loss of graft function.

Conclusions The mixed resultsmay be attributable to limited sample sizes. Also, some PROmeasures may lack sensitivity to detect actual changes, as they exclude issues and domains of life likely to be important forQoL post-transplantation and when patients may no longer perceive themselves to have diabetes. Thus, the full impact of islet ⁄ pancreas transplantation (alone or after kidney) on QoL is unknown. Furthermore, no studies have assessed patient satisfaction, which may highlight further advantages and disadvantages of transplantation.

Colloid probe AFM study of thermal collapse and protein interactions of poly(N-isopropylacrylamide) coatings

Graft coatings of poly(N-isopropylacrylamide) (pNIPAM) are of considerable interest for the reversible control of bio-interfacial interactions. In this study, graft coatings were prepared by free radical polymerisation from surface-bound polymerisable groups, on silicon wafers and quartz crystal microbalance (QCM) sensors. QCM with dissipation monitoring showed a gradual, extended phase change as the temperature increased. Colloid probe atomic force microscopy (CP-AFM) revealed a marked change in the compressibility of the coating below and above the lower critical solution temperature (LCST). Force curves showed an approximate 9-fold reduction in thickness between 24 °C and 38 °C, yet the collapsed coating at 38 °C still had a thickness significantly higher than the ellipsometrically determined dry thickness, indicating a residual extent of hydration above the LCST. At all temperatures, interaction force curves showed steric repulsion, though over different distances. There was little hysteresis between approach and retract force curves, which is evidence for almost instantaneous relaxation of the coating upon decompression. CP-AFM using a probe coated with bovine serum albumin (BSA) showed repulsive interactions with little approach/retraction hysteresis below the LCST, indicating lack of adhesion between the pNIPAM coating and the BSA-coated probe. In contrast, above the LCST the force curves on retraction were characteristic of adhesion, while the approach curves were still repulsive, and the adhesion increased in strength as the temperature was increased further beyond the LCST. Thus, QCM-D and CP-AFM data correlated well in showing a gradual nature of the phase transition and a concomitant gradual change in the interaction force with BSA.

3D fibrous structures as cardiovascular implants

Medical textiles are a highly specialised stream of technical textiles industry with a growing range of applications. A significant advancement has been achieved in surgical products or biomedical textiles (implantable/non-implantable) with the advent of 3D textile manufacturing techniques. Cardiovascular soft tissue implants (vascular grafts) have been a field of interest over decades for use of innovative 3D tubular structures in treatment of cardiovascular diseases. In the field of soft tissue implants, knitted and woven tubular structures are being used for large diameter blood vessel replacements. Advent of electrospinning and tissue engineering techniques has been able to provide promising answers to small diameter vascular grafts. The aim of this review is to outline the approaches in vascular graft development utilising different 3D tubular structure forming techniques. The emphasis is on vascular graft development techniques that can help improve treatment efficacy in future.