In vitro osteogenic cell proliferation, mineralization, and in vivo osseointegration of injection molded high-density polyethylene-based hybrid composites in rabbit animal model

The present work reports the biocompatibility property of injection molded HDPE-HA-Al2O3 hybrid composites. In vitro cytocompatibility results reveal that osteogenic cell viability and bone mineralization are favorably supported in a statistically significant manner on HDPE-20% HA-20% Al2O3 composite, in comparison to HDPE-40 wt.% HA or HDPE-40 wt.% Al2O3. The difference in cytocompatibility property is explained in terms of difference in substrate wettability/surface energy and importantly, both the cell proliferation at 7 days or bone mineralization at 21 days on HDPE-20% HA-20% Al2O3 composite are either comparable or better than sintered HA. The progressive healing of cylindrical femoral bone defects in rabbit animal model was assessed by implantation experiments over 1, 4 and 12 weeks. Based on the histological analysis as well as histomorphometrical evaluation, a better efficacy of HDPE-20% HA-20% Al2O3 over high-density polyethylene (HDPE) for bone regeneration and neobone formation at host bone-implant interface was established. Taken together, the present study unequivocally establishes that despite the presence of 20% Al2O3, HDPE-based hybrid composites are as biocompatible as HA in vitro or better than HDPE in vivo.

The control of crystallographic texture in the use of magnesium as a resorbable biomaterial

Magnesium and its alloys are an emerging class of resorbable materials for orthopedic and cardiovascular applications. The typical strategy underlying the development of these materials involves the control of material processing routes and the addition of alloying elements. Crystallographic texture is known to control bulk mechanical as well as surface properties. However, its role in determining the properties of magnesium for implant materials has not been well studied. In this work, an extruded rod of pure magnesium was cut in multiple directions to generate samples with different textures. It was found that texture significantly affected the strength and ductility of magnesium. Corrosion rates in Hank's solution decreased with the increased presence of low energy basal planes at the surface. In vitro cell studies revealed that changes in texture did not induce cytotoxicity. Thus, the control of texture in magnesium based implants could be used to tailor the mechanical properties and the resorption rates without compromising cytocompatibility. This study elucidates the importance of texture in the use of magnesium as a resorbable biomaterial.

Long-Term Sustained Release of Salicylic Acid from Cross-Linked Biodegradable Polyester Induces a Reduced Foreign Body Response in Mice

There has been a continuous surge toward developing new biopolymers that exhibit better in vivo biocompatibility properties in terms of demonstrating a reduced foreign body response (FBR). One approach to mitigate the undesired FBR is to develop an implant capable of releasing anti-inflammatory molecules in a sustained manner over a long time period. Implants causing inflammation are also more susceptible to infection. In this article, the in vivo biocompatibility of a novel, biodegradable salicylic acid releasing polyester (SAP) has been investigated by subcutaneous implantation in a mouse model. The tissue response to SAP was compared with that of a widely used biodegradable polymer, poly(lactic acid-co-glycolic acid) (PLGA), as a control over three time points: 2, 4, and 16 weeks postimplantation. A long-term in vitro study illustrates a continuous, linear (zero order) release of salicylic acid with a cumulative mass percent release rate of 7.34 x 10(-4) h(-1) over similar to 1.5-17 months. On the basis of physicochemical analysis, surface erosion for SAP and bulk erosion for PLGA have been confirmed as their dominant degradation modes in vivo. On the basis of the histomorphometrical analysis of inflammatory cell densities and collagen distribution as well as quantification of proinflammatory cytokine levels (TNF-alpha and IL-1 beta), a reduced foreign body response toward SAP with respect to that generated by PLGA has been unambiguously established. The favorable in vivo tissue response to SAP, as manifest from the uniform and well-vascularized encapsulation around the implant, is consistent with the decrease in inflammatory cell density and increase in angiogenesis with time. The above observations, together with the demonstration of long-term and sustained release of salicylic acid, establish the potential use of SAP for applications in improved matrices for tissue engineering and chronic wound healing.

Absence of systemic toxicity in mouse model towards BaTiO3 nanoparticulate based eluate treatment

One of the existing issues in implant failure of orthopedic biomaterials is the toxicity induced by the fine particles released during long term use in vivo, leading to acute inflammatory response. In developing a new class of piezobiocomposite to mimic the integrated electrical and mechanical properties of bone, bone-mimicking physical properties as well as in vitro cytocompatibility properties have been achieved with spark plasma sintered hydroxyapatite (HA)-barium titanate (BaTiO3) composites. However, the presence of BaTiO3 remains a concern towards the potential toxicity effect. To address this issue, present work reports the first result to conclusively confirm the non-toxic effect of HA-BaTiO3 piezobiocomposite nanoparticulates, in vivo. Twenty BALB/c mice were intraarticularly injected at their right knee joints with different concentrations of HA-BaTiO3 composite of up to 25 mg/ml. The histopathological examination confirmed the absence of any trace of injected particles or any sign of inflammatory reaction in the vital organs, such as heart, spleen, kidney and liver at 7 days post-exposure period. Rather, the injected nanoparticulates were found to be agglomerated in the vicinity of the knee joint, surrounded by macrophages. Importantly, the absence of any systemic toxicity response in any of the vital organs in the treated mouse model, other than a mild local response at the site of delivery, was recorded. The serum biochemical analyses using proinflammatory cytokines (TNF-alpha and IL-1 beta) also complimented to the non-immunogenic response to injected particulates. Altogether, the absence of any inflammatory/ adverse reaction will open up myriad of opportunities for BaTiO3 based piezoelectric implantable devices in biomedical applications.

Emergency Handling in MICS based Body Area Network

Body Area Network, a new wireless networking paradigm, promises to revolutionize the healthcare applications. A number of tiny sensor nodes are strategically placed in and around the human body to obtain physiological information. The sensor nodes are connected to a coordinator or a data collector to form a Body Area Network. The tiny devices may sense physiological parameters of emergency in nature (e.g. abnormality in heart bit rate, increase of glucose level above the threshold etc.) that needs immediate attention of a physician. Due to ultra low power requirement of wireless body area network, most of the time, the coordinator and devices are expected to be in the dormant mode, categorically when network is not operational. This leads to an open question, how to handle and meet the QoS requirement of emergency data when network is not operational? Emergency handling becomes more challenging at the MAC layer, if the channel access related information is unknown to the device with emergency message. The aforementioned scenarios are very likely scenarios in a MICS (Medical Implant Communication Service, 402-405 MHz) based healthcare systems. This paper proposes a mechanism for timely and reliable transfer of emergency data in a MICS based Body Area Network. We validate our protocol design with simulation in a C++ framework. Our simulation results show that more than 99 p ercentage of the time emergency messages are reached at the coordinator with a delay of 400ms.

Structural and Magnetic Phase Transformations of Hydroxyapatite-Magnetite Composites under Inert and Ambient Sintering Atmospheres

The present work reports the impact of sintering conditions on the phase stability in hydroxyapatite (HA) magnetite (Fe3O4) bulk composites, which were densified using either pressureless sintering in air or by rapid densification via hot pressing in inert atmosphere. In particular, the phase abundances, structural and magnetic properties of the (1-x)HA-xFe(3)O(4) (x = 5, 10, 20, and 40 wt %) composites were quantified by corroborating results obtained from Rietveld refinement of the X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and Mossbauer spectroscopy. Post heat treatment phase analysis revealed a major retention of Fe3O4 in argon atmosphere, while it was partially/completely oxidized to hematite (alpha-Fe2O3) in air. Mossbauer results suggest the high-temperature diffusion of Fe3+ into hydroxyapatite lattice, leading to the formation of Fe-doped HA. A preferential occupancy of Fe3+ at the Ca(1) and Ca(2) sites under hot-pressing and conventional sintering conditions, respectively, was observed. The lattice expansion in HA from Rietveld analysis correlated well with the amounts of Fe-doped HA determined from the Mossbauer spectra. Furthermore, hydroxyapatite in the monoliths and composites was delineated to exist in the monoclinic (P2(1)/b) structure as against the widely reported hexagonal (P6(3)/m) crystal lattice. The compositional similarity of iron doping in hydroxyapatite to that of tooth enamel and bone presents HA-Fe3O4 composites as potential orthopedic and dental implant materials.

Biocompatibility property of 100% strontium-substituted SiO2-Al2O3-P2O5-CaO-CaF2 glass ceramics over 26 weeks implantation in rabbit model: Histology and micro-Computed Tomography analysis

One of the desired properties for any new biomaterial composition is its long-term stability in a suitable animal model and such property cannot be appropriately assessed by performing short-term implantation studies. While hydroxyapatite (HA) or bioglass coated metallic biomaterials are being investigated for in vivo biocompatibility properties, such study is not extensively being pursued for bulk glass ceramics. In view of their inherent brittle nature, the implant stability as well as impact of long-term release of metallic ions on bone regeneration have been a major concern. In this perspective, the present article reports the results of the in vivo implantation experiments carried out using 100% strontium (Sr)-substituted glass ceramics with the nominal composition of 4.5 SiO2-3Al(2)O(3)-1.5P(2)O(5)-3SrO-2SrF(2) for 26 weeks in cylindrical bone defects in rabbit model. The combination of histological and micro-computed tomography analysis provided a qualitative and quantitative understanding of the bone regeneration around the glass ceramic implants in comparison to the highly bioactive HA bioglass implants (control). The sequential polychrome labeling of bone during in vivo osseointegration using three fluorochromes followed by fluorescence microscopy observation confirmed homogeneous bone formation around the test implants. The results of the present study unequivocally confirm the long-term implant stability as well as osteoconductive property of 100% Sr-substituted glass ceramics, which is comparable to that of a known bioactive implant, that is, HA-based bioglass. (c) 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 1168-1179, 2015.

Twinning induced enhancement of fracture toughness in ultrafine grained Hydroxyapatite-Calcium Titanate composites

Despite being highly bioactive and biocompatible, the limitations of monolithic hydroxyapatite (HA) include extremely low fracture toughness, poor electrical conductivity. While addressing these issues, the present study demonstrates how CaTiO3 (CT) addition to HA can be utilized to obtain a combination of long crack fracture toughness (1.7 MPa m(1/2) SEVNB technique) and flexural strength of 98-155 MPa (3-point bending) and a moderate tensile strength (diametral compression) of 17-36 MPa. The enhancement in fracture resistance in spark plasma sintered HA-CT composites has been explained in reference to the observed twin morphology. TEM reveals the presence of twins in CT grains due to 1800 rotation about 101]. The measured properties along with our earlier reports on biocompatibility and electrical properties make HA-CT suitable for bone tissue engineering applications. When compared with other competing HA-based biocomposites, HA-CT composites are found to have a better combination of properties useful for medium load bearing implant applications. (C) 2015 Elsevier Ltd. All rights reserved.

Strength reliability and in vitro degradation of three-dimensional powder printed strontium-substituted magnesium phosphate scaffolds

Strontium ions (Sr2+) are known to prevent osteoporosis and also encourage bone formation. Such twin requirements have motivated researchers to develop Sr-substituted biomaterials for orthopaedic applications. The present study demonstrates a new concept of developing Sr-substituted Mg-3(PO4)(2) - based biodegradable scaffolds. In particular, this work reports the fabrication, mechanical properties with an emphasis on strength reliability as well as in vitro degradation of highly biodegradable strontium-incorporated magnesium phosphate cements. These implantable scaffolds were fabricated using three-dimensional powder printing, followed by high temperature sintering and/or chemical conversion, a technique adaptable to develop patient-specific implants. A moderate combination of strength properties of 36.7 MPa (compression), 242 MPa (bending) and 10.7 MPa (tension) were measured. A reasonably modest Weibull modulus of up to 8.8 was recorded after uniaxial compression or diametral tensile tests on 3D printed scaffolds. A comparison among scaffolds with varying compositions or among sintered or chemically hardened scaffolds reveals that the strength reliability is not compromised in Sr-substituted scaffolds compared to baseline Mg-3(PO4)(2). The micro-computed tomography analysis reveals the presence of highly interconnected porous architecture in three-dimension with lognormal pore size distribution having median in the range of 17.74-26.29 mu m for the investigated scaffolds. The results of extensive in vitro ion release study revealed passive degradation with a reduced Mg2+ release and slow but sustained release of Sr2+ from strontium-substituted magnesium phosphate scaffolds. Taken together, the present study unequivocally illustrates that the newly designed Sr-substituted magnesium phosphate scaffolds with good strength reliability could be used for biomedical applications requiring consistent Sr2+-release, while the scaffold degrades in physiological medium. Statement of significance The study investigates the additive manufacturing of scaffolds based on different strontium-substituted magnesium phosphate bone cements by means of three-dimensional powder printing technique (3DPP). Magnesium phosphates were chosen due to their higher biodegradability compared to calcium phosphates, which is due to both a higher solubility as well as the absence of phase changes (to low soluble hydroxyapatite) in vivo. Since strontium ions are known to promote bone formation by stimulating osteoblast growth, we aimed to establish such a highly degradable magnesium phosphate ceramic with an enhanced bioactivity for new bone ingrowth. After post-processing, mechanical strengths of up to 36.7 MPa (compression), 24.2 MPa (bending) and 10.7 MPa (tension) could be achieved. Simultaneously, the failure reliability of those bioceramic implant materials, measured by Weibull modulus calculations, were in the range of 4.3-8.8. Passive dissolution studies in vitro proved an ion release of Mg2+ and PO43- as well as Sr2+, which is fundamental for in vivo degradation and a bone growth promoting effect. In our opinion, this work broadens the range of bioceramic bone replacement materials suitable for additive manufacturing processing. The high biodegradability of MPC ceramics together with the anticipated promoting effect on osseointegration opens up the way for a patient-specific treatment with the prospect of a fast and complete healing of bone fractures. (C) 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Characterisation of cell adhesion to substrate materials and the resistance to enzymatic and mechanical cell-removal

Cell-implant adhesive strength is important for prostheses. In this paper, an investigation is described into the adhesion of bovine chondrocytes to Ti6Al4V-based substrates with different surface roughnesses and compositions. Cells were cultured for 2 or 5 days, to promote adhesion. The ease of cell removal was characterised, using both biochemical (trypsin) and mechanical (accelerated buoyancy and liquid flow) methods. Computational fluid dynamics (CFD) modelling has been used to estimate the shear forces applied to the cells by the liquid flow. A comparison is presented between the ease of cell detachment indicated using these methods, for the three surfaces investigated. © 2008 Materials Research Society.

Osteoblast and monocyte responses to 444 ferritic stainless steel intended for a Magneto-Mechanically Actuated Fibrous Scaffold

The rationale behind this work is to design an implant device, based on a ferromagnetic material, with the potential to deform in vivo promoting osseointegration through the growth of a healthy periprosthetic bone structure. One of the primary requirements for such a device is that the material should be non-inflammatory and non-cytotoxic. In the study described here, we assessed the short-term cellular response to 444 ferritic stainless steel; a steel, with a very low interstitial content and a small amount of strong carbide-forming elements to enhance intergranular corrosion resistance. Two different human cell types were used: (i) foetal osteoblasts and (ii) monocytes. Austenitic stainless steel 316L, currently utilised in many commercially available implant designs, and tissue culture plastic were used as the control surfaces. Cell viability, proliferation and alkaline phosphatase activity were measured. In addition, cells were stained with alizarin red and fluorescently-labelled phalloidin and examined using light, fluorescence and scanning electron microscopy. Results showed that the osteoblast cells exhibited a very similar degree of attachment, growth and osteogenic differentiation on all surfaces. Measurement of lactate dehydrogenase activity and tumour necrosis factor alpha protein released from human monocytes indicated that 444 stainless steel did not cause cytotoxic effects or any significant inflammatory response. Collectively, the results suggest that 444 ferritic stainless steel has the potential to be used in advanced bone implant designs. © 2011 Elsevier Ltd.

Evolución de los cuidados de enfermería durante el S.XX y hasta la actualidad

La evolución de los cuidados enfermeros en España está íntimamente relacionado con el concepto de salud-enfermedad de cada época histórica. En este presente trabajo se muestra como desde mediados del siglo XX los cuidados adquieren un papel auxiliar del médico hasta llegar a la profesionalización de la enfermería, donde el cuidado se conforma desde una perspectiva holística y se trabaja en ámbitos como la docencia, la gestión y la investigación. En el año 1952 se produce la unificación de enfermeras, practicantes y matronas en la figura de ayudante técnico sanitario (ATS), fecha crucial para comprender la identidad enfermera. Se van estableciendo nuevos modelos de salud y la atención sanitaria se va enfocando hacia áreas como la promoción y la prevención de la salud. De este modo, se implantó una metodología de trabajo propia, denominada Proceso de Atención de Enfermería y se creó la necesidad de un lenguaje común, apareciendo entonces las Taxonomías NANDA, NOC y NIC. Como enfermeras además de prestar cuidados debemos tener una visión amplia del pensamiento crítico, basando los cuidados en enfoques basados en la evidencia. En el año 1977 se produce la integración de los estudios de enfermería en la Universidad bajo el título de Diplomado Universitario de Enfermería y con la Ordenación de Enseñanzas Superiores (2007), se adquiere la titulación de Grado en Enfermería. La historia de nuestra profesión sirve como instrumento de reflexión sobre lo que significa ser enfermero y para poder entenderla y conocerla, es imprescindible el estudio de una investigación histórica.

Dense, efficient chip-to-chip communication at the extremes of computing

The scalability of CMOS technology has driven computation into a diverse range of applications across the power consumption, performance and size spectra. Communication is a necessary adjunct to computation, and whether this is to push data from node-to-node in a high-performance computing cluster or from the receiver of wireless link to a neural stimulator in a biomedical implant, interconnect can take up a significant portion of the overall system power budget. Although a single interconnect methodology cannot address such a broad range of systems efficiently, there are a number of key design concepts that enable good interconnect design in the age of highly-scaled CMOS: an emphasis on highly-digital approaches to solving ‘analog’ problems, hardware sharing between links as well as between different functions (such as equalization and synchronization) in the same link, and adaptive hardware that changes its operating parameters to mitigate not only variation in the fabrication of the link, but also link conditions that change over time. These concepts are demonstrated through the use of two design examples, at the extremes of the power and performance spectra.

A novel all-digital clock and data recovery technique for high-performance, high density interconnect has been developed. Two independently adjustable clock phases are generated from a delay line calibrated to 2 UI. One clock phase is placed in the middle of the eye to recover the data, while the other is swept across the delay line. The samples produced by the two clocks are compared to generate eye information, which is used to determine the best phase for data recovery. The functions of the two clocks are swapped after the data phase is updated; this ping-pong action allows an infinite delay range without the use of a PLL or DLL. The scheme's generalized sampling and retiming architecture is used in a sharing technique that saves power and area in high-density interconnect. The eye information generated is also useful for tuning an adaptive equalizer, circumventing the need for dedicated adaptation hardware.

On the other side of the performance/power spectra, a capacitive proximity interconnect has been developed to support 3D integration of biomedical implants. In order to integrate more functionality while staying within size limits, implant electronics can be embedded onto a foldable parylene (‘origami’) substrate. Many of the ICs in an origami implant will be placed face-to-face with each other, so wireless proximity interconnect can be used to increase communication density while decreasing implant size, as well as facilitate a modular approach to implant design, where pre-fabricated parylene-and-IC modules are assembled together on-demand to make custom implants. Such an interconnect needs to be able to sense and adapt to changes in alignment. The proposed array uses a TDC-like structure to realize both communication and alignment sensing within the same set of plates, increasing communication density and eliminating the need to infer link quality from a separate alignment block. In order to distinguish the communication plates from the nearby ground plane, a stimulus is applied to the transmitter plate, which is rectified at the receiver to bias a delay generation block. This delay is in turn converted into a digital word using a TDC, providing alignment information.

Avaliação in vitro da variação do torque de remoção de parafusos para fixação de pilares protéticos submetidos a ciclos de parafusamento e desparafusamento

O afrouxamento dos parafusos protéticos é descrito na literatura como uma das complicações mais frequentes das próteses sobre implantes. Durante sua confecção, os profissionais sentem necessidade de remover várias vezes as próteses e/ou componentes protéticos, soltando e re-apertando os parafusos repetidamente. O principal objetivo deste trabalho foi avaliar a variação do torque de remoção de parafusos de fixação de pilares protéticos a implantes osteointegráveis após sucessivos ciclos de parafusamento e desparafusamento. Outro objetivo foi avaliar a influência do hexágono da base do pilar no torque de remoção dos parafusos. Para isso, foram utilizados 20 implantes de plataforma regular com hexágono externo e 20 pilares protéticos sextavados, que foram parafusados aos implantes com um parafuso de titânio, aplicando-se a este um torque de 32Ncm, por meio de um torquímetro digital. Os conjuntos implante/pilar/parafuso foram divididos em dois grupos: (1) pilares cujo hexágono da base foram removidos e (2) pilares convencionais, com hexágono na base. Cada conjunto recebeu uma restauração provisória e foi submetido a ciclagem mecânica por 15 minutos. Depois, os parafusos foram removidos, medindo-se o torque de remoção. Esta sequência foi repetida dez vezes e então o parafuso foi trocado por outro sem uso, e mais um ciclo foi realizado. Uma análise de regressão linear demonstrou nos dois grupos uma queda do torque de remoção do parafuso ao longo dos repetidos ciclos de inserção/remoção. A comparação entre os coeficientes da regressão nos dois grupos não revelou diferença entre eles. Também não houve diferença entre as médias das 5 últimas repetições e o 11 ciclo, com o parafuso novo. Concluiu-se que (1) repetidos parafusamentos e desparafusamentos promoveram a diminuição progressiva do torque de remoção dos parafusos, (2) a troca do parafuso por outro sem uso após dez ciclos de inserção/remoção não aumentou sua resistência ao afrouxamento, e (3) a remoção do hexágono da base do pilar protético não exerceu nenhum efeito sobre o torque de remoção do parafuso.

Avaliação in vivo da densidade óssea ao redor de implantes osteointegráveis com diferentes plataformas

Os implantes osteointegráveis assumiram condição prioritária na reabilitação da perda dentária unitária ou múltipla em função das elevadas taxas de sucesso e previsibilidade no tratamento e vêm sendo cada vez mais utilizados por especialistas e clínicos. Atualmente existe a preocupação com a manutenção dos tecidos moles periimplantares, principalmente em áreas estéticas. De modo geral, um ano após a instalação dos implantes osteointegráveis ocorre uma perda óssea proximal de 1,5 mm e em média 0,1 mm durante os anos subsequentes. Nos últimos anos, achados clínicos evidenciaram menor perda óssea inicial associada a intermediários de diâmetro reduzido em relação à plataforma dos implantes. Com o objetivo de comparar, por meio de imagens radiográficas o comportamento ósseo proximal ao redor de implantes osteointegráveis com plataformas convencionais e plataformas de diâmetro intermediário reduzido, foi estabelecido o seguinte desenho de estudo clínico prospectivo: em 08 pacientes totalmente edentados, foram instalados 40 implantes, 5 implantes mandibulares por paciente. Cada paciente recebeu 3 implantes com plataforma convencional e 2 com plataforma associada aos intermediários de diâmetro reduzido (cone morse). Foram confeccionadas próteses em resina acrílica e fixadas precocemente aos implantes por intermédio de parafusos, seguindo o modelo protocolo Bränemark. Foram feitas radiografias periapicais padronizadas em intervalos de 21 dias, 3, 6 e 12 meses, após a instalação dos implantes. As imagens radiográficas foram digitalizadas e realizada a subtração radiográfica digital pelo programa emago, sendo comparadas com a radiografia inicial. Os resultados obtidos neste estudo mostraram uma regularidade no remodelamento ósseo ao longo do tempo para todos os implantes, não tendo sido encontradas diferenças significativas entre os diferentes implantes analisados.