Anesthetic management of a patient with congenital diaphragmatic eventration.

Congenital diaphragmatic eventration is uncommon in adults and is caused by paralysis, aplasia or atrophy of the muscular fibers of the diaphragm. It may cause severe dyspnea, orthopnea and hypoxia in adult patients. Most symptomatic patients may be managed efficiently without the need for surgical correction, although any event that leads to an increase in intra-abdominal pressure puts them at the risk of spontaneous diaphragmatic rupture. This case report presents the successful anesthetic management of an adult female with congenital diaphragmatic eventration undergoing diagnostic laparoscopy and hysteroscopy using a total intravenous anesthesia technique. Essential steps to prevent any rise in intrathoracic and intra-abdominal pressures along with care to minimize intragastric volume were taken.

UHMWPE-MWCNT-nHA based hybrid trilayer nanobiocomposite: Processing approach, physical properties, stem/bone cell functionality, and blood compatibility.

The development of polymeric nanocomposites for biomedical applications remains a major challenge in terms of tailored addition of nanoparticles to realize the simultaneous enhancement of fracture resistance and cell/blood compatibility. To address this, the present work has been planned to determine whether small addition of surface functionalized multiwalled-carbon-nanotube, MWCNT (<1.5 wt%) and egg-shell derived nanosized hydroxyapatite, nHA (<10 wt%) to ultrahigh-molecular-weight-polyethylene (UHMWPE) can significantly improve the physical properties as well as biocompatibility. The difference in mouse osteoblast and human mesenchymal stem cell (hMSc) proliferation has been validated using both the monolithic composite and a trilayered composite with two different UHMWPE nanocomposites on either face with pure polymer at the middle. The combination of rheology and micro-CT with fractography reveals the homogeneous dispersion of nanofillers, leading to mechanical property enhancement. The quantitative analysis of cell viability and cell spreading by immunocytochemistry method, using vinculin and vimentin expression, establish significant cytocompatibility with hMSc and osteoblast cells onto the trilayer hybrid nanobiocomposite substrates. The hemocompatibility of the investigated composites under the controlled flow of rabbit blood in a microfluidic device reveals the signature of reduced thrombogenesis with reduction of platelet activation on UHMWPE nanocomposite w.r.t. unreinforced UHMWPE. An attempt has been made to discuss the blood compatibility results in the backdrop of the bovine serum albumin adsorption kinetics. Summarizing, the present study establishes that the twin requirement of mechanical property and cyto/hemo-compatibility can be potentially realized in developing trilayer composites in UHMWPE-nHA-MWCNT system.

3D inkjet printing of biomaterials with strength reliability and cytocompatibility: Quantitative process strategy for Ti-6Al-4V.

Among additive manufacturing (AM) techniques, laser or electron beam based processes have been widely investigated for metallic implants. Despite the potential in manufacturing of patient-specific biomedical implants, 3D inkjet powder printing (3DIJPP, a variant of AM) of biomaterials is still in its infancy, as little is known quantitatively about the transient process physics and dynamics. An equally important challenge has been the ink formulation to manufacture biomaterials with reliable mechanical properties and desired biocompatibility. We have developed, for the very first time, the theoretical foundation and experimental formulation of a unique process strategy involving the 'on-demand' delivery of a novel in situ polymerisable acrylic ink system to print a model biomaterial, Ti-6Al-4V. The post-ejection in-flight dynamics of ink droplets have been captured in situ by employing high speed stroboscopic shadowgraphy, to quantitatively estimate the dimensionless numbers of fluid physics for 'printability' assessment. Washburn model was adapted extensively to quantify the capillary ink infiltration time in porous powder bed of finite thickness. On the other hand, particle tracking mode in diffusing wave spectroscopy (DWS) was exploited to analyse the timescale for effective binding of powder particles during in situ polymerisation. The clinically relevant combination of 3D porous architecture with 98.4% interconnectivity among 10-40 µm pores together with modest combination of elastic modulus (4 GPa) and strength reliability (Weibull modulus ∼8.1) establish the potential of inkjet printed Ti-6Al-4V as cortical bone analogue. A better cell attachment, viability, cytoskeletal spreading with pronounced proliferation of murine fibroblasts and pre-osteoblasts on 3DIJPP Ti-6Al-4V, when benchmarked against the metallurgically processed (commercial) or selective laser melted (SLM) Ti-6Al-4V, has been demonstrated, in vitro. The enhanced cellular activities on the 3DIJPP Ti-6Al-4V was explained in terms of an interplay among the elastic stiffness, surface roughness and wettability against the same benchmarking. It is conceived that the quantitative understanding of the integrated process physics and dynamics to print Ti-6Al-4V with reliable mechanical properties together with better cytocompatibility can lead to a paradigm shift in adapting the scalable 3DIJPP for manufacturing of metallic biomaterials.