Vacuum assisted closure and local drug delivery systems in spinal infections: A review of current evidence.

Background: Spinal infections are still showing increased incidence throughout the years as our surgical capabilities increase, coupled with an overall aging population with greater number of chronic comorbidities. The management of spinal infection is of utmost importance, due to high rates of morbidity and mortality, on top of the general difficulty in eradicating spinal infection due to the ease of hematogenous spread in the spine. We aim to summarize the utility of vacuum-assisted closure (VAC) and local drug delivery systems (LDDS) in the management of spinal infections. Methods: A narrative review was conducted. All studies that were related to the use of VAC and LDDS in Spinal Infections were included in the study. Results: A total of 62 studies were included in this review. We discussed the utility of VAC as a tool for the management of wounds requiring secondary closure, as well as how it is increasingly being used after primary closure as prophylaxis for surgical site infections in high-risk wounds of patients undergoing spinal surgery. The role of LDDS in spinal infections was also discussed, with preliminary studies showing good outcomes when patients were treated with various novel LDDS. Conclusions: We have summarized and given our recommendations for the use of VAC and LDDS for spinal infections. A treatment algorithm has also been established, to act as a guide for spine surgeons to follow when tackling various spinal infections in day-to-day clinical practice.

Experimental Demonstration of Compact Polymer Mass Transfer Device Manufactured by Additive Manufacturing with Hydrogel Integration to Bio-Mimic the Liver Functions.

In this paper, we designed and demonstrated a stimuli-responsive hydrogel that mimics the mass diffusion function of the liver. We have controlled the release mechanism using temperature and pH variations. Additive manufacturing technology was used to fabricate the device with nylon (PA-12), using selective laser sintering (SLS). The device has two compartment sections: the lower section handles the thermal management, and feeds temperature-regulated water into the mass transfer section of the upper compartment. The upper chamber has a two-layered serpentine concentric tube; the inner tube carries the temperature-regulated water to the hydrogel using the given pores. Here, the hydrogel is present in order to facilitate the release of the loaded methylene blue (MB) into the fluid. By adjusting the fluid's pH, flow rate, and temperature, the deswelling properties of the hydrogel were examined. The weight of the hydrogel was maximum at 10 mL/min and decreased by 25.29% to 10.12 g for the flow rate of 50 mL/min. The cumulative MB release at 30 °C increased to 47% for the lower flow rate of 10 mL/min, and the cumulative release at 40 °C climbed to 55%, which is 44.7% more than at 30 °C. The MB release rates considerably increased when the pH dropped from 12 to 8, showing that the lower pH had a major impact on the release of MB from the hydrogel. Only 19% of the MB was released at pH 12 after 50 min, and after that, the release rate remained nearly constant. At higher fluid temperatures, the hydrogels lost approximately 80% of their water in just 20 min, compared to a loss of 50% of their water at room temperature. The outcomes of this study may contribute to further developments in artificial organ design.

Mechanical behaviour of additively manufactured bioactive glass/high density polyethylene composites.

Bioactive glass (BAG) is a well-known biomaterial that can form a strong bond with hard and soft tissues and can also aid in bone regeneration. In this study, BAG is added to a polymer to induce bioactivity and to realize fused filament fabrication (FFF) based printing of polymer composites for potential orthopaedic implant applications. BAG (5, 10, and 20 wt%) is melt compounded with high density polyethylene (HDPE) and subsequently extruded into feedstock filament for FFF-printing. Tensile tests on developed filaments reveal that they are stiff enough to resist forces exerted during the printing process. Micrography of printed HDPE/BAG reveals perfect diffusion of raster interface indicating proper selection of printing parameters. Micrography of freeze fractured prints shows the homogeneous distribution and good dispersion of filler across the matrix. The tensile, flexural, and compressive modulus of FFF-printed HDPE/BAG parts increases with filler addition. BAG addition to the HDPE matrix enhances flexural and compressive strength. The tensile and flexural behaviour of FFF-prints is comparable to injection molded counterparts. Property maps exhibit the merits of present study over the existing literature pertaining to desired bone properties and polymer composites used in biomedical applications. It is envisioned that the development of HDPE/BAG composites for FFF-printing can lead to possible orthopaedic implants and scaffolds to mimic the bone properties in customised anatomical sites or injuries.