This study reports the vision status of a presbyopic patient who has undergone a corneal inlay procedure. The study
hopes to provide optometrists more insight on the procedure and the co-management involved in such a patient. The
patient, a 48 years-old Chinese woman with presbyopia underwent the corneal inlay procedure three years ago.
She had the inlay implanted in the non-dominant eye to aid near vision i.e. her left eye. The pre and post-operative
evaluations include distance and near visual acuity, fundoscopy, tonometry, Schirmer’s test, slit lamp evaluation, corneal
topography and corneal pachymetry. Near visual acuity for the left eye improved from N14 to N5 immediately after
the procedure. Even after 3 years of post-operative followup, the patient was still able to maintain her near vision. In
conclusion, the corneal inlay procedure helped to improve near vision of this presbyopic patient. Optometrist plays
a very important role in the co-management of such patients alongside with the ophthalmologist in terms of visual
functional assessments pre and post-surgery, counseling of the procedure and managing patients’ expectations.
Artificial bone is a suitable alternative to autografts and allografts, however their use is still limited. Though there were numerous reports on their structural properties, permeability studies of artificial bones were comparably scarce. This study focused on the development of idealised, structured models of artificial cancellous bone and compared their permeability values with bone surface area and porosity. Cancellous bones from fresh bovine femur were extracted and cleaned following an established protocol. The samples were scanned using micro-computed tomography (μCT) and three-dimensional models of the cancellous bones were reconstructed for morphology study. Seven idealised and structured cancellous bone models were then developed and fabricated via rapid prototyping technique. A test-rig was developed and permeability tests were performed on the artificial and real cancellous bones. The results showed a linear correlation between the permeability and the porosity as well as the bone surface area. The plate-like idealised structure showed a similar value of permeability to the real cancellous bones.
In the current study, a sol-gel-synthesized tricalcium magnesium silicate powder was coated on Ti-6Al-4V alloys using plasma spray method. Composition of feed powder was evaluated by X-ray diffraction technique before and after the coating process. Scanning electron microscopy and atomic force microscopy were used to study the morphology of coated substrates. The corrosion behaviors of bare and coated Ti-6Al-4V alloys were examined using potentiodynamic polarization test and electrochemical impedance spectroscopy in stimulated body fluids. Moreover, bare and coated Ti-6Al-4V alloys were characterized in vitro by culturing osteoblast and mesenchymal stem cells for several days. Results demonstrated a meaningful improvement in the corrosion resistance of Ti-6Al-4V alloys coated with tricalcium magnesium silicate compared with the bare counterparts, by showing a decrease in corrosion current density from 1.84 μA/cm2 to 0.31 μA/cm2. Furthermore, the coating substantially improved the bioactivity of Ti-6Al-4Valloys. Our study on corrosion behavior and biological response of Ti-6Al-4V alloy coated by tricalcium magnesium silicate proved that the coating has considerably enhanced safety and applicability of Ti-6Al-4V alloys, suggesting its potential use in permanent implants and artificial joints.
Iron and its alloy have been proposed as biodegradable metals for temporary medical implants. However, the formation of iron oxide and iron phosphate on their surface slows down their degradation kinetics in both in vitro and in vivo scenarios. This work presents new approach to tailor degradation behavior of iron by incorporating biodegradable polymers into the metal. Porous pure iron (PPI) was vacuum infiltrated by poly(lactic-co-glycolic acid) (PLGA) to form fully dense PLGA-infiltrated porous iron (PIPI) and dip coated into the PLGA to form partially dense PLGA-coated porous iron (PCPI). Results showed that compressive strength and toughness of the PIPI and PCPI were higher compared to PPI. A strong interfacial interaction was developed between the PLGA layer and the iron surface. Degradation rate of PIPI and PCPI was higher than that of PPI due to the effect of PLGA hydrolysis. The fast degradation of PIPI did not affect the viability of human fibroblast cells. Finally, this work discusses a degradation mechanism for PIPI and the effect of PLGA incorporation in accelerating the degradation of iron.
Developing multifaceted, biocompatible, artificial implants for tissue engineering is a growing field of research. In recent times, several works have been reported about the utilization of biomolecules in combination with synthetic materials to achieve this process. Accordingly, in this study, the ability of an extract obtained from Aloe vera, a commonly used medicinal plant in influencing the biocompatibility of artificial material, is scrutinized using metallocene polyethylene (mPE). The process of coating dense fibrous Aloe vera extract on the surface of mPE was carried out using microwaves. Then, several physicochemical and blood compatibility characterization experiments were performed to disclose the effects of corresponding surface modification. The Fourier transform infrared spectrum showed characteristic vibrations of several active constituents available in Aloe vera and exhibited peak shifts at far infrared regions due to aloe-based mineral deposition. Meanwhile, the contact angle analysis demonstrated a drastic increase in wettability of coated samples, which confirmed the presence of active components on glazed mPE surface. Moreover, the bio-mimic structure of Aloe vera fibers and the influence of microwaves in enhancing the coating characteristics were also meticulously displayed through scanning electron microscopy micrographs and Hirox 3D images. The existence of nanoscale roughness was interpreted through high-resolution profiles obtained from atomic force microscopy. And the extent of variations in irregularities was delineated by measuring average roughness. Aloe vera-induced enrichment in the hemocompatible properties of mPE was established by carrying out in vitro tests such as activated partial thromboplastin time, prothrombin time, platelet adhesion, and hemolysis assay. In conclusion, the Aloe vera-glazed mPE substrate was inferred to attain desirable properties required for multifaceted biomedical implants.
Malignant chest wall tumour is rare. The presentation is usually aggressive that requires extensive resection to prevent recurrence. However, the extensive resection is to the expense of causing defect on the chest wall and hence, respiratory mechanics. Two cases of chest wall tumour are discussed including the surgical approach of radical tumour resection which was combined with placement of titanium mesh and Tranverse Rectus Abdominis Myocutaneus (TRAM) flap to cover the defect and preserve respiratory mechanical functions. The morbidity of using titanium mesh demonstrated in the case series were infection and injury to surrounding tissue due to its rigidity and large size which required its removal. However the formation of 'pseudopleura' made the thoracic cage return back as closed cavity even after the removal of the titanium mesh and allow normal respiratory functions.
Biofilms are a complex group of microbial cells that adhere to the exopolysaccharide matrix present on the surface of medical devices. Biofilm-associated infections in the medical devices pose a serious problem to the public health and adversely affect the function of the device. Medical implants used in oral and orthopedic surgery are fabricated using alloys such as stainless steel and titanium. The biological behavior, such as osseointegration and its antibacterial activity, essentially depends on both the chemical composition and the morphology of the surface of the device. Surface treatment of medical implants by various physical and chemical techniques are attempted in order to improve their surface properties so as to facilitate bio-integration and prevent bacterial adhesion. The potential source of infection of the surrounding tissue and antimicrobial strategies are from bacteria adherent to or in a biofilm on the implant which should prevent both biofilm formation and tissue colonization. This article provides an overview of bacterial biofilm formation and methods adopted for the inhibition of bacterial adhesion on medical implants.
Matched MeSH terms: Prostheses and Implants/microbiology*
Morphological surface modifications have been reported to enhance the performance of biomedical implants. However, current methods of introducing graded porosity involves postprocessing techniques that lead to formation of microcracks, delamination, loss of fatigue strength, and, overall, poor mechanical properties. To address these issues, we developed a microwave sintering procedure whereby pure titanium powder can be readily densified into implants with graded porosity in a single step. Using this approach, surface topography of implants can be closely controlled to have a distinctive combination of surface area, pore size, and surface roughness. In this study, the effect of various surface topographies on in vitro response of neonatal rat calvarial osteoblast in terms of attachment and proliferation is studied. Certain graded surfaces nearly double the chance of cell viability in early stages (∼one month) and are therefore expected to improve the rate of healing. On the other hand, while the osteoblast morphology significantly differs in each sample at different periods, there is no straightforward correlation between early proliferation and quantitative surface parameters such as average roughness or surface area. This indicates that the nature of cell-surface interactions likely depends on other factors, including spatial parameters.
Mid-facial defect is one of the most disfiguring and impairing defects. A design of prosthesis that is aesthetic and stable can be precious to a patient who has lost part of his face due to surgical excision. Prosthesis can restore the patients' self-esteem and confidence, which affects the patients and their life style. The aim of this case report is to describe a technique of mid-facial silicone prosthesis fabrication.
With the development of communication technologies, the use of wireless systems in biomedical implanted devices has become very useful. Bio-implantable devices are electronic devices which are used for treatment and monitoring brain implants, pacemakers, cochlear implants, retinal implants and so on. The inductive coupling link is used to transmit power and data between the primary and secondary sides of the biomedical implanted system, in which efficient power amplifier is very much needed to ensure the best data transmission rates and low power losses. However, the efficiency of the implanted devices depends on the circuit design, controller, load variation, changes of radio frequency coil's mutual displacement and coupling coefficients. This paper provides a comprehensive survey on various power amplifier classes and their characteristics, efficiency and controller techniques that have been used in bio-implants. The automatic frequency controller used in biomedical implants such as gate drive switching control, closed loop power control, voltage controlled oscillator, capacitor control and microcontroller frequency control have been explained. Most of these techniques keep the resonance frequency stable in transcutaneous power transfer between the external coil and the coil implanted inside the body. Detailed information including carrier frequency, power efficiency, coils displacement, power consumption, supplied voltage and CMOS chip for the controllers techniques are investigated and summarized in the provided tables. From the rigorous review, it is observed that the existing automatic frequency controller technologies are more or less can capable of performing well in the implant devices; however, the systems are still not up to the mark. Accordingly, current challenges and problems of the typical automatic frequency controller techniques for power amplifiers are illustrated, with a brief suggestions and discussion section concerning the progress of implanted device research in the future. This review will hopefully lead to increasing efforts towards the development of low powered, highly efficient, high data rate and reliable automatic frequency controllers for implanted devices.
The use of wireless communication using inductive links to transfer data and power to implantable microsystems to stimulate and monitor nerves and muscles is increasing. This paper deals with the development of the theoretical analysis and optimization of an inductive link based on coupling and on spiral circular coil geometry. The coil dimensions offer 22 mm of mutual distance in air. However, at 6 mm of distance, the coils offer a power transmission efficiency of 80% in the optimum case and 73% in the worst case via low input impedance, whereas, transmission efficiency is 45% and 32%, respectively, via high input impedance. The simulations were performed in air and with two types of simulated human biological tissues such as dry and wet-skin using a depth of 6 mm. The performance results expound that the combined magnitude of the electric field components surrounding the external coil is approximately 98% of that in air, and for an internal coil, it is approximately 50%, respectively. It can be seen that the gain surrounding coils is almost constant and confirms the omnidirectional pattern associated with such loop antennas which reduces the effect of non-alignment between the two coils. The results also show that the specific absorption rate (SAR) and power loss within the tissue are lower than that of the standard level. Thus, the tissue will not be damaged anymore.
Blood compatibility of metallocene polyethylene (mPE) was investigated after modifying the surface using hydrochloric acid. Contact angle of the mPE exposed to HCl poses a decrease in its value which indicates increasing wettability and better blood compatibility. Surface of mPE analyzed by using FTIR revealed no significant changes in its functional groups after treatment. Furthermore, scanning electron microscope images supported the increasing wettability through the modifications like pit formations and etching on the acid rendered surface. To evaluate the effect of acid treatment on the coagulation cascade, prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured. Both PT and APTT were delayed significantly (P < 0.05) after 60 min exposure implying improved blood compatibility of the surfaces. Hemolysis assay of the treated surface showed a remarkable decrease in the percentage of lysis of red blood cells when compared with untreated surface. Moreover, platelet adhesion assay demonstrated that HCl exposed surfaces deter the attachment of platelets and thereby reduce the chances of activation of blood coagulation cascade. These results confirmed the enhanced blood compatibility of mPE after HCl exposure which can be utilized for cardiovascular implants like artificial vascular prostheses, implants, and various blood contacting devices.
Matched MeSH terms: Prostheses and Implants/adverse effects; Prostheses and Implants/ultrastructure*
The development of implanted devices is essential because of their direct effect on the lives and safety of humanity. This paper presents the current issues and challenges related to all methods used to harvest energy for implantable biomedical devices. The advantages, disadvantages, and future trends of each method are discussed. The concept of harvesting energy from environmental sources and human body motion for implantable devices has gained a new relevance. In this review, the harvesting kinetic, electromagnetic, thermal and infrared radiant energies are discussed. Current issues and challenges related to the typical applications of these methods for energy harvesting are illustrated. Suggestions and discussion of the progress of research on implantable devices are also provided. This review is expected to increase research efforts to develop the battery-less implantable devices with reduced over hole size, low power, high efficiency, high data rate, and improved reliability and feasibility. Based on current literature, we believe that the inductive coupling link is the suitable method to be used to power the battery-less devices. Therefore, in this study, the power efficiency of the inductive coupling method is validated by MATLAB based on suggested values. By further researching and improvements, in the future the implantable and portable medical devices are expected to be free of batteries.
Cardiovascular biomaterials (CB) dominate the category of biomaterials based on the demand and investments in this field. This review article classifies the CB into three major classes, namely, metals, polymers, and biological materials and collates the information about the CB. Blood compatibility is one of the major criteria which limit the use of biomaterials for cardiovascular application. Several key players are associated with blood compatibility and they are discussed in this paper. To enhance the compatibility of the CB, several surface modification strategies were in use currently. Some recent applications of surface modification technology on the materials for cardiovascular devices were also discussed for better understanding. Finally, the current trend of the CB, endothelization of the cardiac implants and utilization of induced human pluripotent stem cells (ihPSCs), is also presented in this review. The field of CB is growing constantly and many new investigators and researchers are developing interest in this domain. This review will serve as a one stop arrangement to quickly grasp the basic research in the field of CB.
Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.
An alternative robust method for testing the equality of central tendency measures was developed by integrating H Statistic with adaptive trimmed mean using hinge estimator, HQ. H Statistic is known for its ability to control Type I error rates and HQ is a robust location estimator. This robust estimator used asymmetric trimming technique, where it trims the tail of the distribution based on the characteristic of that particular distribution. To investigate on the performance (i.e. robustness) of the procedure, some variables were manipulated to create conditions which are known to highlight its strengths and weaknesses. Bootstrap method was used to test the hypothesis. The integration seemed to produce promising robust procedure that is capable of addressing the problem of violations to the assumptions. About 20% trimming is the appropriate amount of trimming for the procedure, where this amount is found to be robust in most conditions. This procedure was also proven to be robust as compared to the parametric (AN0vA) and non parametric (Kruskal-Wallis) methods.
Understanding of kinematics force applied at the elbow is important in many fields, including biomechanics, biomedical engineering and rehabilitation. This paper provides a comparison of a mathematical model of elbow joint using three different types of prosthetics for transhumeral user, and characterizes the forces required to overcome the passive mechanical of the prosthetics at the residual limb.
Hydroxyapatite (HA) coated implant is more susceptible to bacterial infection as the micro-structure surface which is beneficial for osseointegration, could also become a reservoir for bacterial colonisation. The aim of this study was to introduce the antibacterial effect of silver (Ag) to the biomineralised HA by utilising a polydopamine film as an intermediate layer for Ag and HA immobilisation. Sufficient catechol groups in polydopamine were required to bind chemically stainless steel 316 L, Ag and HA elements. Different amounts of Ag nanoparticles were metallised on the polydopamine grafted stainless steel by varying the immersion time in silver nitrate solution from 12 to 24 h. Another polydopamine layer was then formed on the metallised film, followed by surface biomineralisation in 1.5 Simulated Body Fluid (SBF) solution for 3 days. Several characterisation techniques including X-Ray Photoelectron Spectroscopy, Atomic Force Microscopy, Scanning Electron Microscopy and Contact Angle showed that Ag nanoparticles and HA agglomerations were successfully immobilised on the polydopamine film through an element reduction process. The Ag metallisation at 24 h has killed the viable bacteria with 97.88% of bactericidal ratio. The Ag was ionised up to 7 days which is crucial to prevent bacterial infection during the first stage of implant restoration. The aged functionalised films were considered stable due to less alteration of its chemical composition, surface roughness and wettability properties. The ability of the functionalised film to coat complex and micro scale metal make it suitable for dental and orthopaedic implants application.
Matched MeSH terms: Prostheses and Implants/microbiology