Development of an instrumented customizable total knee prosthesis for experimental tests.

Total knee arthroplasty (TKA) has revolutionized the life of millions of patients and it is the most efficient treatment in cases of osteoarthritis. The increase in life expectancy has lowered the average age of the patient, which requires a more enduring and performing prosthesis. To improve the design of implants and satisfying the patient's needs, a deep understanding of the knee Biomechanics is needed. To overcome the uncertainties of numerical models, recently instrumented knee prostheses are spreading. The aim of the thesis was to design and manifacture a new prototype of instrumented implant, able to measure kinetics and kinematics (in terms of medial and lateral forces and patellofemoral forces) of different interchangeable designs of prosthesis during experiments tests within a research laboratory, on robotic knee simulator. Unlike previous prototypes it was not aimed for industrial applications, but purely focusing on research. After a careful study of the literature, and a preliminary analytic study, the device was created modifying the structure of a commercial prosthesis and transforming it in a load cell. For monitoring the kinematics of the femoral component a three-layers, piezoelettric position sensor was manifactured using a Velostat foil. This sensor has responded well to pilot test. Once completed, such device can be used to validate existing numerical models of the knee and of TKA and create new ones, more accurate.It can lead to refinement of surgical techniques, to enhancement of prosthetic designs and, once validated, and if properly modified, it can be used also intraoperatively

Utilizzo dell'ipossia come stimolo per il differenziamento condrocitico di cellule staminali.

Date le sollecitazioni meccaniche alle quali è sottoposta, la cartilagine, soprattutto quella articolare, è facilmente danneggiabile e la mancanza di vascolarizzazione la rende un tessuto incapace di auto-rigenerarsi. Il fallimento della chirurgia tradizionale ha incentivato negli ultimi venti anni lo sviluppo di nuove tecniche di ingegneria tissutale che prevedono la rigenerazione del tessuto cartilagineo in vitro, e il suo successivo impianto nella zona lesionata. Generalmente si preferisce utilizzare cellule staminali mesenchimali adulte (MSCs), e il tessuto adiposo si è rivelata la fonte di estrazione più conveniente.Inoltre le ATSCs (Adipose Tissue Stem Cells) possono essere facilmente isolate dalla componente vasculo-stromale (SVF) del tessuto adiposo prelevata in seguito a un intervento di liposuzione: quindi, a differenza delle MSCs estratte da midollo osseo (BMSCs- Bone Marrow Stem Cells), la loro estrazione dal paziente richiede un intervento meno invasivo e meno rischioso. Il tessuto cartilagineo non è raggiunto dai vasi sanguigni, e la sua formazione nella fase embrionale avviene ad una concentrazione di O2 notevolmente inferiore a quella ambientale. Questo ha indotto gli studiosi a pensare che un ambiente ipossico possa non soltanto favorire il differenziamento condrogenico di cellule staminali in coltura, ma anche facilitare il mantenimento del fenotipo condrocitico, mimando l'ambiente fisiologico avascolare della cartilagine.Lo scopo di questa tesi è stato la messa a punto di un protocollo di coltura cellulare in condizioni di ipossia per indurre differenziamento condrogenico di ATSCs. La metodica standardizzata verrà impiegata in laboratorio per sviluppare la ricerca di base nello studio della rigenerazione della cartilagine

Multi-organ support device for combined extracorporeal carbon dioxide removal and hemofiltration treatments with pump-free solution for ultrafiltration

The use of extracorporeal organ support (ECOS) devices is increasingly widespread, to temporarily sustain or replace the functions of impaired organs in critically ill patients. Among ECOS, respiratory functions are supplied by extracorporeal life support (ECLS) therapies like extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R), and renal replacement therapies (RRT) are used to support kidney functions. However, the leading cause of mortality in critically ill patients is multi-organ dysfunction syndrome (MODS), which requires a complex therapeutic strategy where extracorporeal treatments are often integrated to pharmacological approach. Recently, the concept of multi-organ support therapy (MOST) has been introduced, and several forms of isolated ECOS devices are sequentially connected to provide simultaneous support to different organ systems. The future of critical illness goes towards the development of extracorporeal devices offering multiple organ support therapies on demand by a single hardware platform, where treatment lines can be used alternately or in conjunction. The aim of this industrial PhD project is to design and validate a device for multi-organ support, developing an auxiliary line for renal replacement therapy (hemofiltration) to be integrated on a platform for ECCO2R. The intended purpose of the ancillary line, which can be connected on demand, is to remove excess fluids by ultrafiltration and achieve volume control by the infusion of a replacement solution, as patients undergoing respiratory support are particularly prone to develop fluid overload. Furthermore, an ultrafiltration regulation system shall be developed using a powered and software-modulated pinch-valve on the effluent line of the hemofilter, proposed as an alternative to the state-of-the-art solution with peristaltic pump