8 research outputs found

    A short review of medical-grade stainless steel: Corrosion resistance and novel techniques

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    Due to its exceptional quality as a biomedical metal, stainless steel is often utilized to produce a broad range of medical tools. The resistance of stainless steel to corrosion is a key indicator of how long and how effective it will serve its intended purpose, and it is an important factor in determining the biocompatibility of the material. However, due to the complex physiological environment within the human body, the corrosion management of medical-grade stainless steel is facing several challenges. In this article, an overview of the factors that influence the corrosion performance of medical-grade stainless steel is provided, and new technologies and methods that have been developed in recent years to improve the corrosion resistance are discussed. These cutting-edge methods are expected to improve the corrosion resistance and longevity of medical-grade stainless steel, providing strong support for the increased applicability of the material in the medical industry

    Topographical hard protective coating for joint replacement implants

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    Joint replacement surgery, essential for managing joint diseases, requires improvements in tribocorrosion performance to ensure surgical success and longevity of joint implants. Transition-metal light-element (TMLE) compound coatings, known for their high hardness and chemical stability, have been extensively researched and applied for surface protection of joint implants. However, these coatings typically lack a lubrication phase, leading to high friction coefficients and severe corrosion wear, which makes long-term effective protection challenging. A promising approach is to utilize the natural lubricating proteins present in body fluids, which are continuously available and can thus address long-term service issues of TMLE coatings. In this work, we utilized micro-arc oxidation (MAO) technology to develop an underlying morphology, then conformally deposited a TiB2 layer, resulting in a cratered dual-layer TiB2/MAO coating. This unique cratered dual-layer structure not only preserves the high hardness and wear resistance of TiB2 but also aims to (1) absorb wear particles to prevent abrasive wear and (2) increase surface energy to optimize protein lubrication capacity. Consequently, the TiB2/MAO coating exhibits low friction coefficients and wear rates in protein-containing simulated body fluids. Furthermore, the dual-layer TiB2/MAO coating demonstrates excellent corrosion resistance and biocompatibility. This dual-layer coating design synergistically combines the superior intrinsic properties of material with unique structural construction, while also harnessing continuously available external proteins as lubricants to further optimize performance, thereby introducing an advanced strategy for developing protective coatings for implant materials.</p

    Adsorption Structure and Coverage-Dependent Orientation Analysis of Sub-Monolayer Acetonitrile on TiO2(110)

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    The adsorption structure and orientation of acetonitrile on TiO2(110) have been investigated by temperature-programmed desorption (TPD) and high resolution broadband sum frequency generation vibrational spectroscopy (HR-BB-SFGVS) in combination with ab initio molecular dynamics (AIMD) simulation. Sub-monolayer, monolayer, and multilayer states of acetonitrile on TiO2(110) have been unambiguously distinguished in the TPD spectra. The in situ HR-BB-SFG vibrational spectra of acetonitrile on TiO2(110) at 100 K not only show the symmetric stretching mode of the methyl group and the nitrile group, similar to those of vapor acetonitrile on oxide surfaces, but also present an intense antisymmetric stretching mode of the methyl group as well as the sum resonance mode between symmetric C-C stretching and symmetric CH3 deformation. Besides, two adsorption forms for acetonitrile on TiO2(110), including interactions with five-coordinated titanium (Tice) and bridge bonded oxygen (Obr) vacancies, have also been resolved and identified in our SFG vibrational spectra. By the combination of SFG polarization analyses and AIMD simulations, we further found that the tilt angle of CH3CN on TiO2(110) decreases as the coverage increases from submonolayer to monolayer. Considering the down shifts of desorption temperature, vibrational frequency, and adsorption energy for acetonitrile on TiO2(110) at higher coverage, we propose that the intermolecular repulsion plays a major role in the coverage-dependent adsorption configuration. Our results not only provide a detailed insight into the adsorption states of acetonitrile on TiO2(110) at a low temperature but also demonstrates the capabilities of high-resolution SFG-VS for investigating the complicated structure and orientation of adsorbates on single-crystal metal oxides

    Initiation of continuous renal replacement therapy versus intermittent hemodialysis in critically ill patients with severe acute kidney injury: a secondary analysis of STARRT-AKI trial

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    Background: There is controversy regarding the optimal renal-replacement therapy (RRT) modality for critically ill patients with acute kidney injury (AKI). Methods: We conducted a secondary analysis of the STandard versus Accelerated Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial to compare outcomes among patients who initiated RRT with either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD). We generated a propensity score for the likelihood of receiving CRRT and used inverse probability of treatment with overlap-weighting to address baseline inter-group differences. The primary outcome was a composite of death or RRT dependence at 90-days after randomization. Results: We identified 1590 trial participants who initially received CRRT and 606 who initially received IHD. The composite outcome of death or RRT dependence at 90-days occurred in 823 (51.8%) patients who commenced CRRT and 329 (54.3%) patients who commenced IHD (unadjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.75-1.09). After balancing baseline characteristics with overlap weighting, initial receipt of CRRT was associated with a lower risk of death or RRT dependence at 90-days compared with initial receipt of IHD (OR 0.81; 95% CI 0.66-0.99). This association was predominantly driven by a lower risk of RRT dependence at 90-days (OR 0.61; 95% CI 0.39-0.94). Conclusions: In critically ill patients with severe AKI, initiation of CRRT, as compared to IHD, was associated with a significant reduction in the composite outcome of death or RRT dependence at 90-days

    A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

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    Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation

    Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.

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    ObjectivesAmong patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.DesignSecondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.gov number NCT02568722).SettingOne hundred-fifty-three ICUs in 13 countries.PatientsAltogether 2693 critically ill patients with AKI, of whom 994 were North American, 1143 European, and 556 from Australia and New Zealand (ANZ).InterventionsNone.Measurements and main resultsTotal mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p p p p p p p p = 0.007).ConclusionsAmong STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions
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