An Evaluation of Parylene Thin Films to Prevent Encrustation for a Urinary Bladder Pressure MEMS Sensor System

Recent developments in urological implants have focused on preventive strategies to mitigate encrustation and biofilm formation. Parylene, a conformal, pinhole-free polymer coating, has gained attention due to its high biocompatibility and chemical resistance, excellent barrier properties, and low friction coefficient. This study aims to evaluate the effectiveness of parylene C in comparison to a parylene VT4 grade coating in preventing encrustation on a urinary bladder pressure MEMS sensor system. Additionally, silicon oxide (SiOx) applied as a finish coating was investigated for further improvements. An in vitro encrustation system mimicking natural urine flow was used to quantify the formation of urinary stones. These stones were subsequently analyzed using Fourier transform infrared spectrometry (FTIR). Encrustation results were then discussed in relation to coating surface chemical properties. Parylene C and VT4 grades demonstrated a very low encrustation mass, making them attractive options for encrustation prevention. The best performance was achieved after the addition of a hydrophilic SiOx finish coating on parylene VT4 grade. Parylene-based encapsulation proved to be an outstanding solution to prevent encrustation for urological implants

Drivers and patterns of land biosphere carbon balance reversal

The carbon balance of the land biosphere is the result of complex interactions between land, atmosphere and oceans, including climatic change, carbon dioxide fertilization and land-use change. While the land biosphere currently absorbs carbon dioxide from the atmosphere, this carbon balance might be reversed under climate and land-use change (‘carbon balance reversal’). A carbon balance reversal would render climate mitigation much more difficult, as net negative emissions would be needed to even stabilize atmospheric carbon dioxide concentrations. We investigate the robustness of the land biosphere carbon sink under different socio-economic pathways by systematically varying climate sensitivity, spatial patterns of climate change and resulting land-use changes. For this, we employ a modelling framework designed to account for all relevant feedback mechanisms by coupling the integrated assessment model IMAGE with the process-based dynamic vegetation, hydrology and crop growth model LPJmL. We find that carbon balance reversal can occur under a broad range of forcings and is connected to changes in tree cover and soil carbon mainly in northern latitudes. These changes are largely a consequence of vegetation responses to varying climate and only partially of land-use change and the rate of climate change. Spatial patterns of climate change as deduced from different climate models, substantially determine how much pressure in terms of global warming and land-use change the land biosphere will tolerate before the carbon balance is reversed. A reversal of the land biosphere carbon balance can occur as early as 2030, although at very low probability, and should be considered in the design of so-called peak-and-decline strategies.Bundesministerium für Bildung und Forschung http://dx.doi.org/10.13039/501100002347Peer Reviewe

Letter to the editor, international urology and nephrology—in silico–in vitro–in vivo: can numerical simulations based on computational fluid dynamics (CFD) replace studies of the urinary tract?

Background and aim!#!In cardiorenal syndrome (CRS) type 1, acute cardiac failure or acute decompensation of chronic heart failure causes acute kidney injury (AKI). Every individual AKI episode increases the risk for chronic kidney disease (CKD) in the long term. In this study, we aimed to evaluate epidemiological characteristics and outcome variables of CRS type 1 individuals from the nephrologist's perspective.!##!Methods!#!The study was performed in a retrospective, observational manner. All AKI patients treated at the Brandenburg Hospital of the Medical School of Brandenburg between January and December 2019 were screened for diagnostic criteria of CRS type 1. Endpoints were in-hospital death, need for dialysis, and renal recovery.!##!Results!#!During the screening, 198 out of 1189 (16.6%) AKI subjects were assigned to the diagnosis CRS type 1. The overall in-hospital mortality was 19.2%; 9.6% of the patients required dialysis due to AKI. Complete recovery of kidney function was observed in 86 individuals (43.4%); incomplete recovery occurred in 55 patients (27.8%). Mortality-predictive variables were AKIN stage 2, longer ICU treatment, and insulin-dependent diabetes. Regarding dialysis, AKIN stage 3 and higher potassium at the time of diagnosis were predictive. Subjects with longer in-hospital stay recovered more often from CRS type 1.!##!Conclusions!#!The incidence of CRS type 1 is high (∼16% of all in-hospital AKI subjects) and the mortality is higher than the average mortality of AKI in general. At the same time, complete recovery of kidney function occurs less frequent. The kidney-related follow-up management of CRS type 1 needs to be significantly optimized to improve the long-term outcome of affected patients

Prevention of Encrustation on Ureteral Stents: Which Surface Parameters Provide Guidance for the Development of Novel Stent Materials?

Encrustations of ureteral stents are one of the biggest problems with urological implants. Crystalline biofilms can occur alone or in combination with bacterial biofilms. To identify which surface parameters provide guidance for the development of novel stent materials, we used an in vitro encrustation system. Synthetic urine with increasing pH to simulate an infection situation was pumped over the polymer samples with adjusted flow rates at 37 °C to mimic the native body urine flow. Chemical surface features (contact angle, surface charge), as well as encrustations were characterized. The encrustations on the materials were analyzed quantitatively (dry mass) and qualitatively using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and Fourier transform infrared spectroscopy (FTIR). The aim of this comparative study was to identify crucial surface parameters that might predict the quantity and type of mineral deposits in vitro and provide guidance for the development and screening of new polymer-based biomaterials for ureteral stent design. For the first time, we could identify that, within the range of our polymers, those materials with a slight hydrophilicity and a strong negative zeta potential (around −60 mV) were most favorable for use as ureteral stent materials, as the deposition of crystalline biofilms was minimized

Urinary Stent Development and Evaluation Models: In Vitro, Ex Vivo and In Vivo—A European Network of Multidisciplinary Research to Improve Urinary Stents (ENIUS) Initiative

Background: When trying to modify urinary stents, certain pre-clinical steps have to be followed before clinical evaluation in humans. Usually, the process starts as an in silico assessment. The urinary tract is a highly complex, dynamic and variable environment, which makes a computer simulation closely reflecting physiological conditions extremely challenging. Therefore, the pre-clinical evaluation needs to go through further steps of in vitro, ex vivo and in vivo assessments. Methods and materials: Within the European Network of Multidisciplinary Research to Improve Urinary Stents (ENIUS), the authors summarized and evaluated stent assessment models in silico, in vitro, ex vivo and in vivo. The topic and relevant sub-topics were researched in a systematic literature search in Embase, Scope, Web of Science and PubMed. Clinicaltrials.gov was consulted for ongoing trials. Articles were selected systematically according to guidelines with non-relevant, non-complete, and non-English or Spanish language articles excluded. Results: In the first part of this paper, we critically evaluate in vitro stent assessment models used over the last five decades, outlining briefly their strengths and weaknesses. In the second part, we provide a step-by-step guide on what to consider when setting up an ex vivo model for stent evaluation on the example of a biodegradable stent. Lastly, the third part lists and discusses the pros and cons of available animal models for urinary stent evaluation, this being the final step before human trials. Conclusions: We hope that this overview can provide a practical guide and a critical discussion of the experimental pre-clinical evaluation steps needed, which will help interested readers in choosing the right methodology from the start of a stent evaluation process once an in silico assessment has been completed. Only a transparent multidisciplinary approach using the correct methodology will lead to a successful clinical implementation of any new or modified stent

Drivers and patterns of land biosphere carbon balance reversal

The carbon balance of the land biosphere is the result of complex interactions between land, atmosphere and oceans, including climatic change, carbon dioxide fertilization and land-use change. While the land biosphere currently absorbs carbon dioxide from the atmosphere, this carbon balance might be reversed under climate and land-use change ('carbon balance reversal'). A carbon balance reversal would render climate mitigation much more difficult, as net negative emissions would be needed to even stabilize atmospheric carbon dioxide concentrations. We investigate the robustness of the land biosphere carbon sink under different socio-economic pathways by systematically varying climate sensitivity, spatial patterns of climate change and resulting land-use changes. For this, we employ a modelling framework designed to account for all relevant feedback mechanisms by coupling the integrated assessment model IMAGE with the process-based dynamic vegetation, hydrology and crop growth model LPJmL. We find that carbon balance reversal can occur under a broad range of forcings and is connected to changes in tree cover and soil carbon mainly in northern latitudes. These changes are largely a consequence of vegetation responses to varying climate and only partially of land-use change and the rate of climate change. Spatial patterns of climate change as deduced from different climate models, substantially determine how much pressure in terms of global warming and land-use change the land biosphere will tolerate before the carbon balance is reversed. A reversal of the land biosphere carbon balance can occur as early as 2030, although at very low probability, and should be considered in the design of so-called peak-and-decline strategies

Interactive Effects of Copper-Doped Urological Implants with Tissue in the Urinary Tract for the Inhibition of Cell Adhesion and Encrustation in the Animal Model Rat

The insertion of a ureteral stent provides acute care by restoring urine flow and alleviating urinary retention or dysfunction. The problems of encrustation, bacterial colonization and biofilm formation become increasingly important when ureteral stents are left in place for a longer period of time. One way to reduce encrustation and bacterial adherence is to modify the stent surface with a diamond-like carbon coating, in combination with copper doping. The biocompatibilities of the Elastollan® base material and the a-C:H/Cu-mulitilayer coating were tested in synthetic urine. The copper content in bladder tissue was determined by atomic absorption spectroscopy and in blood and in urine by inductively coupled plasma mass spectrometry. Encrustations on the materials were analyzed by scanning electron microscopy, energy dispersive X-ray spectroscopy and Fourier transform infrared spectroscopy. A therapeutic window for copper ions of 0.5–1.0 mM was determined to kill bacteria without affecting human urothelial cells. In the rat animal model, it was found that copper release did not reach toxic concentrations in the affecting tissue of the urinary tract or in the blood. The encrustation behavior of the surfaces showed that the roughness of the amorphous carbon layer with the copper doping is probably the causal factor for the higher encrustation

Potential strategies to prevent encrustations on urinary stents and catheters – thinking outside the box:a European network of multidisciplinary research to improve urinary stents (ENIUS) initiative

Abstract Introduction: Urinary stents have been around for the last 4 decades, urinary catheters even longer. They are associated with infections, encrustation, migration, and patient discomfort. Research efforts to improve them have shifted onto molecular and cellular levels. ENIUS brought together translational scientists to improve urinary implants and reduce morbidity. Methods & materials: A working group within the ENIUS network was tasked with assessing future research lines for the improvement of urinary implants. Topics were researched systematically using Embase and PubMed databases. Clinicaltrials.gov was consulted for ongoing trials. Areas covered: Relevant topics were coatings with antibodies, enzymes, biomimetics, bioactive nano-coats, antisense molecules, and engineered tissue. Further, pH sensors, biodegradable metals, bactericidal bacteriophages, nonpathogenic uropathogens, enhanced ureteric peristalsis, electrical charges, and ultrasound to prevent stent encrustations were addressed. Expert opinion: All research lines addressed in this paper seem viable and promising. Some of them have been around for decades but are yet to proceed to clinical application (i.e. tissue engineering). Others are very recent and, at least in urology, still only conceptual (i.e. antisense molecules). Perhaps the most important learning point resulting from this pan-European multidisciplinary effort is that collaboration between all stakeholders is not only fruitful but also truly essential