Integrated management of chronic kidney disease: Analysis of an innovative policy in Portugal

The implementation in Portugal of a model for integrated management of disease applied to the end-stage renal disease, from 2008 onwards, has completely restructured the way of providing care, as well as the payment and follow-up of patients under dialysis. This article describes the steps taken by the Ministry of Health, in terms of the planning, implementation and follow-up of the policy, with a particular focus on the importance of involving the various groups of interest, the leadership, as well as the capacity of negotiation and influence of the Government

Precision assessment of model-based RSA for a total knee prosthesis in a biplanar set-up.

Model-based Roentgen stereophotogrammetric Analysis (RSA) was recently developed for the measurement of prosthesis micromotion. Its main advantage is that markers do not need to be attached to the as traditional marker-based RSA requires. Model-based RSA has only been tested in uniplanar radiographic set-ups. A biplanar set-up would theoretically facilitate the pose estimation algorithm, since radiographic projections would show more different shape features of the implants than in uniplanar images. We tested the precision of model-based RSA and compared it with that of the traditional marker-based method in a biplanar set-up. Micromotions of both tibial and femoral components were measured with both the techniques from double examinations of patients participating in a clinical Study. The results showed that in the biplanar Set-up model-based RSA presents a homogeneous distribution of precision for all the translation directions, but an inhomogenous error for rotations, especially internal-external rotation presented higher errors than rotations about the transverse and sagittal axes. Model-based RSA was less precise than the marker-based method, although the difference were not significant for the translations and rotations of the tibial component, with the exception of the internal-external rotations. For both prosthesis components the precisions of model-based RSA were below 0.2 mm for all the translations, and below 0.3 degrees for rotations about transverse and sagittal axes. These values are still acceptable for clinical studies aimed at evaluating total knee prosthesis micromotion. In a biplanar set-tip model-based RSA is a valid alternative to traditional marker-based RSA where marking of the prosthesis is an enormous disadvantage

Versatile magnetic configuration for the control and manipulation of superparamagnetic nanoparticles

The control and manipulation of superparamagnetic nanoparticles (SP-MNP) is a significant challenge and has become increasingly important in various fields, especially in biomedical research. Yet, most of applications rely on relatively large nanoparticles, 50 nm or higher, mainly due to the fact that the magnetic control of smaller MNPs is often hampered by the thermally induced Brownian motion. Here we present a magnetic device able to manipulate remotely in microfluidic environment SP-MNPs smaller than 10 nm. The device is based on a specifically tailored configuration of movable permanent magnets. The experiments performed in 500 mu m capillary have shown the ability to concentrate the SP-MNPs into regions characterized by different shapes and sizes ranging from 100 to 200 mu m. The results are explained by straightforward calculations and comparison between magnetic and thermal energies. We provide then a comprehensive description of the magnetic field intensity and its spatial distribution for the confinement and motion of magnetic nanoparticles for a wide range of sizes. We believe this description could be used to establish accurate and quantitative magnetic protocols not only for biomedical applications, but also for environment, food, security, and other areas

A new approach to scaffold fixation by magnetic forces: Application to large osteochondral defects.

Scaffold fixation represents one of the most serious challenges in osteochondral defect surgery. Indeed, the fixation should firmly hold the scaffold in the implanted position as well as it should guaranty stable bone/scaffold interface for efficient tissue regeneration. Nonetheless successful results have been achieved for small defect repair, the fixation remains really problematic for large defects, i.e. defects with areas exceeding 2 cm(2). This paper advances an innovative magnetic fixation approach based on application of magnetic scaffolds. Finite element modeling was exploited to investigate the fixation efficiency. We considered three magnetic configurations: (1) external permanent magnet ring placed around the leg near the joint; (2) four small permanent magnet pins implanted in the bone underlying the scaffold; (3) four similarly implanted stainless steel pins which magnetization was induced by the external magnet. It was found that for most appropriate magnetic materials and optimized magnet-scaffold positioning all the considered configurations provide a sufficient scaffold fixation. In addition to fixation, we analyzed the pressure induced by magnetic forces at the bone/scaffold interface. Such pressure is known to influence significantly the bone regeneration and could be used for magneto-mechanical stimulatio

Modifying bone scaffold architecture in vivo with permanent magnets to facilitate fixation of magnetic scaffolds.

he fundamental elements of tissue regeneration are cells, biochemical signals and the three-dimensional microenvironment. In the described approach, biomineralized-collagen biomaterial functions as a scaffold and provides biochemical stimuli for tissue regeneration. In addition superparamagnetic nanoparticles were used to magnetize the biomaterials with direct nucleation on collagen fibres or impregnation techniques. Minimally invasive surgery was performed on 12 rabbits to implant cylindrical NdFeB magnets in close proximity to magnetic scaffolds within the lateral condyles of the distal femoral epiphyses. Under this static magnetic field we demonstrated, for the first time in vivo, that the ability to modify the scaffold architecture could influence tissue regeneration obtaining a well-ordered tissue. Moreover, the association between NdFeB magnet and magnetic scaffolds represents a potential technique to ensure scaffold fixation avoiding micromotion at the tissue/biomaterial interface