Designing for validation of medical devices and equipment

Validation is important in the design, development and production of medical devices since effective and appropriate validation plays a vital role in defining the success of a product in both technical and economic terms. Regulations and quality standards lay out the requirements for product validation, but it is left to each individual manufacturer to establish and maintain their own validation procedures. More recently, there has also been a change of emphasis in the regulations and standards that encourage the integration of validation into the development process. However, this poses particular challenges to the manufacturer since there is a distinct lack of guidance to assist this integration. This workbook provides the first real guidance on good design practices for medical device development. It has been developed through extensive consultation with device manufacturers and analysis of regulatory requirements. The approach is intended to assist manufacturers in meeting the new regulations.

[Goiter and nodular thyroid disease: clinical guidelines for diagnosis and treatment. (Waiting? Hormone therapy? Surgery? radioiodine?)]

Nodular thyroid disease is a common problem. We present clinical guidelines for the management of patients with thyroid nodules, multinodular goiters and thyroid cysts for use by primary physicians. In the initial evaluation ultrasonography of the thyroid and fine-needle aspiration biopsy (FNAB) is recommended. FNAB has become the cornerstone in the evaluation of solitary thyroid nodules, cysts and dominant nodules within multinodular goiters. If the procedure is done properly, it should have a false-negative rate of less than 5% and a false-positive rate of not more than 1%. Thyroid radionuclide scans are less frequently used in the initial evaluation of a nodular goiter. Surgery is the primary therapy for patients with nodular thyroid disease. Other available treatment options are radioiodine and TSH-suppression with thyroxine. The main indications for surgery in euthyroid patients with thyroid nodule or with nontoxic multinodular goiter are recently documented or suspected malignancy, compression of the trachea and esophagus, significant growth of the nodule, recurrence of a cyst after aspiration, neck discomfort and cosmetic concern.

Mussel-inspired porous SiO2 scaffolds with improved mineralization and cytocompatibility for drug delivery and bone tissue engineering

Porous SiO2 scaffolds with mesopore structure (named as MS scaffolds) have been proposed as suitable for bone tissue engineering due to their excellent drug-delivery ability; however, the mineralization and cytocompatibility of MS scaffolds are far from optimal for bone tissue engineering, and it is also unclear how the delivery of drugs from MS scaffolds affects osteoblastic cells. The aims of the present study were to improve the mineralization and cytocompatibility of MS scaffolds by coating mussel-inspired polydopamine on the pore walls of scaffolds. The effects of polydopamine modification on MS scaffolds was investigated with respect to apatite mineralization and the attachment, proliferation and differentiation of bone marrow stromal cells (BMSCs), as was the release profile of the drug dexamethasone (DEX). Our results show that polydopamine can readily coat the pore walls of MS scaffolds and that polydopamine-modified MS scaffolds have a significantly improved apatite-mineralization ability as well as better attachment and proliferation of BMSCs in the scaffolds, compared to controls. Polydopamine modification did not alter the release profile of DEX from MS scaffolds but the sustained delivery of DEX significantly improved alkaline phosphatase (ALP) activity of BMSCs in the scaffolds. These results suggest that polydopamine modification is a viable option to enhance the bioactivity of bone tissue engineering scaffolds and, further, that DEX-loaded polydopamine MS scaffolds have potential uses as a release system to enhance the osteogenic properties of bone tissue engineering applications.

Smart design of scaffolds obtained by biofabrication for tissue engineering applications

A engenharia de tecidos é um domínio tecnológico emergente em rápido desenvolvimento que se destina a produzir substitutos viáveis para a restauração, manutenção ou melhoria da função dos tecidos ou órgãos humanos. Uma das estratégias mais predominantes em engenharia de tecidos envolve crescimento celular sobre matrizes de suporte (scaffolds), biocompatíveis e biodegradáveis. Estas matrizes devem possuir não só elevadas propriedades mecânicas e vasculares, mas também uma elevada porosidade. Devido à incompatibilidade destes dois parâmetros, é necessário desenvolver estratégias de simulação de forma a obter estruturas optimizadas. A previsão real das propriedades mecânicas, vasculares e topológicas das matrizes de suporte, produzidas por técnicas de biofabricação, é muito importante para as diversas aplicações em engenharia de tecidos. A presente dissertação apresenta o estado da arte da engenharia de tecidos, bem como as técnicas de biofabricação envolvidas na produção de matrizes de suporte. Para o design optimizado de matrizes de suporte foi adoptada uma metodologia de design baseada tanto em métodos de elementos finitos para o cálculo do comportamento mecânico, vascular e as optimizações topológicas, como em métodos analíticos para a validação das simulações estruturais utilizando dados experimentais. Considerando que as matrizes de suporte são estruturas elementares do tipo LEGO, dois tipos de famílias foram consideradas, superfícies não periódicas e as superfícies triplas periódicas que descrevem superfícies naturais. Os objectivos principais desta dissertação são: i) avaliar as técnicas existentes de engenharia de tecidos; ii) avaliar as técnicas existentes de biofabricação para a produção de matrizes de suporte; iii) avaliar o desempenho e comportamento das matrizes de suporte; iv) implementar uma metodologia de design de matrizes de suporte em variáveis tais como a porosidade, geometria e comportamento mecânico e vascular por forma a auxiliar o processo de design; e por fim, v) validar experimentalmente a metodologia adoptada.