Material Properties and Volumetric Porosity of Biomaterials for Use in Hard Tissue Replacement

Metal implants are a type of hard tissue replacement currently used. Metals used for implants include: stainless steel, titanium, chrome, and cobalt alloys. Such implants often fail at the interface with bone. Metal implants fail when the surface of the implant is coated with an osteoconductive material. An osteoconductive material provides scaffolding for cellular migration, cellular attachment, and cellular distribution. A reason for metal implant failure could be the vastly different material properties than bone. Motivation for the research was to find a suitable bone substitute other than metal. Materials considered were: zirconia toughened alumina, carbon fiber reinforced epoxy, and glass fiber reinforced epoxy. Those materials have been used in previous biological applications and can be cast into complex configurations. Objectives of the study were to compare material properties of the composites to bone. A method to create porosity was then tested in the material that was similar to bone in critical material property. Some of the materials were statistically similar to bone in yield strength. Method to create interconnected porosity in those materials resulted in 49% void space

Method of producing interconnected volumetric porosity in materials

A method to create interconnected porosity in materials that can be poured or injected into a cast. The process allows the arrangement of interconnected volumetric porosity to be directed in materials that are poured or injected into a cast. This process allows a manufacturer to tailor porosity with any size, shape, and configuration with the dissolvable material used to create the pores. This procedure can be applied to medical materials to direct bone growth or implant attachment. These resulting porous materials can include, but is not limited to short fiber reinforced epoxy or epoxy

Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

BackgroundAcute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety.MethodsThe Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacy to create a panel in 2017. The group generated 16 clinical questions related to initial management of cerebral edema in various neurological insults using the PICO format. A research librarian executed a comprehensive literature search through July 2018. The panel screened the identified articles for inclusion related to each specific PICO question and abstracted necessary information for pertinent publications. The panel used GRADE methodology to categorize the quality of evidence as high, moderate, low, or very low based on their confidence that the findings of each publication approximate the true effect of the therapy.ResultsThe panel generated recommendations regarding initial management of cerebral edema in neurocritical care patients with subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, bacterial meningitis, and hepatic encephalopathy.ConclusionThe available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral edema in patients with bacterial meningitis, but not ICH. Differences in therapeutic response and safety may exist between HTS and mannitol. The use of these agents in these critical clinical situations merits close monitoring for adverse effects. There is a dire need for high-quality research to better inform clinicians of the best options for individualized care of patients with cerebral edema