Endophthalmitis caused by Acinetobacter spp. as the presenting manifestation of diabetes mellitus

Purpose We describe a patient with endogenous endophthalmitis caused by Acinetobacter spp. as the first clinical presentation of diabetes mellitus. Method A 48-year-old otherwise healthy woman was referred with signs and symptoms of acute endophthalmitis in the left eye. Systemic work-up, vitreous tap, and intravitreal antibiotic injection were performed followed by pars plana vitrectomy. Results The laboratory tests confirmed the diagnosis of diabetes mellitus. Vitreous culture was positive for Acinetobacter spp., and the organism was sensitive to colistin. One month after surgery, vision was no light perception, and the eye was phthisical. Conclusion Diagnostic work-up should be performed even in otherwise healthy patients with endogenous endophthalmitis. © 2016 Iranian Society of Ophthalmolog

Short-term efficacy of epidural injection of triamcinolone through translaminar approach for the treatment of lumbar canal stenosis

Background: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. Objectives: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. Methods: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). Results: The study population included 32 (28.8) males and 79 (71.2) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r =-0.400, P < 0.001) and BMI (r =-0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r =-0.569, P < 0.001). Conclusions: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis. © 2020, Anesthesiology and Pain Medicine

Mechanical properties of additively manufactured octagonal honeycombs

Honeycomb structures have found numerous applications as structural and biomedical materials due to their favourable properties such as low weight, high stiffness, and porosity. Application of additive manufacturing and 3D printing techniques allows for manufacturing of honeycombs with arbitrary shape and wall thickness, opening the way for optimizing the mechanical and physical properties for specific applications. In this study, the mechanical properties of honeycomb structures with a new geometry, called octagonal honeycomb, were investigated using analytical, numerical, and experimental approaches. An additive manufacturing technique, namely fused deposition modelling, was used to fabricate the honeycomb from polylactic acid (PLA). The honeycombs structures were then mechanically tested under compression and the mechanical properties of the structures were determined. In addition, the Euler-Bernoulli and Timoshenko beam theories were used for deriving analytical relationships for elastic modulus, yield stress, Poisson's ratio, and buckling stress of this new design of honeycomb structures. Finite element models were also created to analyse the mechanical behaviour of the honeycombs computationally. The analytical solutions obtained using Timoshenko beam theory were close to computational results in terms of elastic modulus, Poisson's ratio and yield stress, especially for relative densities smaller than 25%. The analytical solutions based on the Timoshenko analytical solution and the computational results were in good agreement with experimental observations. Finally, the elastic properties of the proposed honeycomb structure were compared to those of other honeycomb structures such as square, triangular, hexagonal, mixed, diamond, and Kagome. The octagonal honeycomb showed yield stress and elastic modulus values very close to those of regular hexagonal honeycombs and lower than the other considered honeycombs.Accepted Author ManuscriptBiomaterials & Tissue Biomechanic

Analytical relationships for the mechanical properties of additively manufactured porous biomaterials based on octahedral unit cells

Additively manufacturing (AM) techniques make it possible to fabricate open-cell interconnected structures with precisely controllable micro-architectures. It has been shown that the morphology, pore size, and relative density of a porous structure determine its macro-scale homogenized mechanical properties and, thus, its biological performance as a biomaterial. In this study, we used analytical, numerical, and experimental techniques to study the elastic modulus, Poisson`s ratio, and yield stress of AM porous biomaterials made by repeating the same octahedral unit cell in all spatial directions. Analytical relationships were obtained based on both Euler-Bernoulli and Timoshenko beam theories by studying a single unit cell experiencing the loads and boundary conditions sensed in an infinite lattice structure. Both single unit cells and corresponding lattice structures were manufactured using AM and mechanically tested under compression to determine the experimental values of mechanical properties. Finite element models of both single unit cell and lattice structure were also built to estimate their mechanical properties numerically. Differences in the bulk mechanical properties of struts built in different directions were observed experimentally and were taken into account in derivation of the analytical solutions. Although the analytical and numerical results were generally in good agreement, the mechanical properties obtained by the Timoshenko beam theory were closer to numerical results. The maximum difference between analytical and numerical results for elastic modulus and Poisson's ratio was below 6%, while for yield stress it was about 13%, both occurring at the relative density of 50%. The maximum difference between the analytical and experimental values of the elastic modulus was &lt;15% (relative density = 50%).Accepted Author ManuscriptBiomaterials & Tissue Biomechanic

Mechanical properties of additively manufactured thick honeycombs

Honeycombs resemble the structure of a number of natural and biological materials such as cancellous bone, wood, and cork. Thick honeycomb could be also used for energy absorption applications. Moreover, studying the mechanical behavior of honeycombs under in-plane loading could help understanding the mechanical behavior of more complex 3D tessellated structures such as porous biomaterials. In this paper, we study the mechanical behavior of thick honeycombs made using additive manufacturing techniques that allow for fabrication of honeycombs with arbitrary and precisely controlled thickness. Thick honeycombs with different wall thicknesses were produced from polylactic acid (PLA) using fused deposition modelling, i.e., an additive manufacturing technique. The samples were mechanically tested in-plane under compression to determine their mechanical properties. We also obtained exact analytical solutions for the stiffness matrix of thick hexagonal honeycombs using both Euler-Bernoulli and Timoshenko beam theories. The stiffness matrix was then used to derive analytical relationships that describe the elastic modulus, yield stress, and Poisson’s ratio of thick honeycombs. Finite element models were also built for computational analysis of the mechanical behavior of thick honeycombs under compression. The mechanical properties obtained using our analytical relationships were compared with experimental observations and computational results as well as with analytical solutions available in the literature. It was found that the analytical solutions presented here are in good agreement with experimental and computational results even for very thick honeycombs, whereas the analytical solutions available in the literature show a large deviation from experimental observation, computational results, and our analytical solutions.Biomaterials & Tissue Biomechanic

How does tissue regeneration influence the mechanical behavior of additively manufactured porous biomaterials?

Although the initial mechanical properties of additively manufactured porous biomaterials are intensively studied during the last few years, almost no information is available regarding the evolution of the mechanical properties of implant-bone complex as the tissue regeneration progresses. In this paper, we studied the effects of tissue regeneration on the static and fatigue behavior of selective laser melted porous titanium structures with three different porosities (i.e. 77, 81, and 85%). The porous structures were filled with four different polymeric materials with mechanical properties in the range of those observed for de novo bone (0.7 GPaAccepted Author ManuscriptBiomaterials & Tissue Biomechanic

Computational prediction of the fatigue behavior of additively manufactured porous metallic biomaterials

The mechanical behavior of additively manufactured porous biomaterials has recently received increasing attention. While there is a relatively large body of data available on the static mechanical properties of such biomaterials, their fatigue behavior is not yet well-understood. That is partly because systematic study of the fatigue behavior of these porous biomaterials is time-consuming and expensive due to the large number of involved factors. In the current study, we propose a computational approach based on finite element method that could be used to predict the fatigue behavior of porous biomaterials given their type of repeating unit cell, dimensions of the unit cell, and S-N curve of the parent material. We applied the proposed approach to predict the fatigue behavior of porous titanium alloy (Ti-6Al-4V) biomaterials manufactured using selective laser melting based on the rhombic dodecahedron unit cell and compared our computational results with experimental observations from one of our recent studies. The evolution of the displacement, elastic modulus, and number of failed struts vs. the number of loading cycle followed a two-stage pattern. In the first stage, there was a relatively slow rate of change in the above-mentioned variables, while they changed very rapidly in the second stage. That compares to the behavior observed in our experimental study. The computationally predicted S-N curve well matched the experimental observations for stress levels not exceeding 60% of the yield stress of the porous structures. For higher stress levels, the presented approach substantially underestimated the fatigue life of the porous structures. The effects of the irregularities caused by the additive manufacturing process on the fatigue behavior of the porous structures were also studied. It was found that those irregularities substantially decrease the fatigue life particularly for lower stress levels.Accepted Author ManuscriptBiomaterials & Tissue Biomechanic

Multiscale modeling of fatigue crack propagation in additively manufactured porous biomaterials

Advances in additive manufacturing (AM) techniques have enabled fabrication of highly porous titanium implants that combine the excellent biocompatibility of bulk titanium with all the benefits that a regular volume-porous structure has to offer (e.g. lower stiffness values comparable to those of bone). Clinical application of such biomaterials requires thorough understanding of their mechanical behavior under loading. Computational models have been therefore developed by various groups for prediction of their quasi-static mechanical properties. The fatigue behavior of AM porous biomaterials is, however, not well understood. In particular, computational models predicting the fatigue response of these structures are rare. That is primarily due to the fact that geometrical features present in computational model of fully porous structures span over multiple length scales. This makes the problem formidably expensive to solve computationally. Here, we propose a multi-scale modeling approach to alleviate this problem and solve the problem of crack propagation in AM porous biomaterials. In this approach, the area around the crack tip is modelled at the micro-scale (using beam elements) while the area far from the crack tip is modeled at the macro-scale (using volumetric elements). Compact-tension notched specimens were fabricated using a selective laser melting machine for validating the results of the presented modeling approach. The multi-scale computational model was found to be capable of predicting the fatigue response observed in experiments.Accepted Author ManuscriptBiomaterials & Tissue Biomechanic