Combined Treatment of Persistent Diabetic Macular Edema with Aflibercept and Triamcinolone Acetonide in Pseudophakic Eyes.

Background and Objectives: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to examine whether the additional intravitreal application of triamcinolone acetonide to continuous anti-vascular endothelial growth factor therapy could improve therapeutic outcomes for pseudophakic eyes with persistent diabetic macular edema. Materials and Methods: twenty-four pseudophakic eyes with refractory diabetic macular edema, that had appeared despite three previously administered intravitreal injections of aflibercept, were divided into two groups (twelve eyes in each group). The first group continued to have aflibercept administered according to a fixed dosing regimen (once in two months). Triamcinolone acetonide 10 mg/0.1 mL (administered once per four months) was included for the second group, i.e., their treatment continued with a combination of aflibercept + triamcinolone acetonide. Results: The reduction in central macular thickness was higher in the eyes treated with combined therapy (aflibercept + triamcinolone acetonide) compared with the use of aflibercept alone during the entire 12-month follow-up period (3rd month p = 0.019; 6th month p = 0.023; 9th month p = 0.027; 12th month p = 0.031). As was evident from the p-values, the differences were statistically significant. No statistically significant difference was recorded for visual acuity: 3rd month p = 0.423; 6th month p = 0.392; 9th month p = 0.413; 12th month p = 0.418. Conclusions: Combined anti-vascular endothelial growth factor and steroid therapy leads to a better anatomical outcome of persistent diabetic macular edema in pseudophakic eyes, but does not lead to a more significant improvement in visual acuity than continuous anti-VEGF therapy alone.

Zeolites as Adsorbents and Photocatalysts for Removal of Dyes from the Aqueous Environment.

This study investigated the potential of zeolites (NH4BETA, NH4ZSM-5, and NaY) to remove two frequently used dyes, methylene blue (MB) and rhodamine B (RB), from an aqueous environment. The removal of dyes with zeolites was performed via two mechanisms: adsorption and photocatalysis. Removal of dyes through adsorption was achieved by studying the Freundlich adsorption isotherms, while photocatalytic removal of dyes was performed under UV irradiation. In both cases, the removal experiments were conducted for 180 min at two temperatures (283 K and 293 K), and dye concentrations were determined spectrophotometrically. Additionally, after photodegradation, mineralization was analyzed as chemical oxygen demand. A computational analysis of the structures of MB and RB was performed to gain a deeper understanding of the obtained results. The computational analysis encompassed density functional theory (DFT) calculations and analysis of two quantum-molecular descriptors addressing the local reactivity of molecules. Experimental results have indicated that the considered zeolites effectively remove both dyes through both mechanisms, especially NH4BETA and NH4ZSM-5, due to the presence of active acidic centers on the outer and inner surfaces of the zeolite. The lowest efficiency of dye removal was achieved in the presence of NaY zeolite, which has a lower SiO2/Al2O3 ratio. A more efficient reduction was completed for RB dye, which agrees with the computationally obtained information about reactivity.

Review of Spider Silk Applications in Biomedical and Tissue Engineering.

This review will present the latest research related to the production and application of spider silk and silk-based materials in reconstructive and regenerative medicine and tissue engineering, with a focus on musculoskeletal tissues, and including skin regeneration and tissue repair of bone and cartilage, ligaments, muscle tissue, peripheral nerves, and artificial blood vessels. Natural spider silk synthesis is reviewed, and the further recombinant production of spider silk proteins. Research insights into possible spider silk structures, like fibers (1D), coatings (2D), and 3D constructs, including porous structures, hydrogels, and organ-on-chip designs, have been reviewed considering a design of bioactive materials for smart medical implants and drug delivery systems. Silk is one of the toughest natural materials, with high strain at failure and mechanical strength. Novel biomaterials with silk fibroin can mimic the tissue structure and promote regeneration and new tissue growth. Silk proteins are important in designing tissue-on-chip or organ-on-chip technologies and micro devices for the precise engineering of artificial tissues and organs, disease modeling, and the further selection of adequate medical treatments. Recent research indicates that silk (films, hydrogels, capsules, or liposomes coated with silk proteins) has the potential to provide controlled drug release at the target destination. However, even with clear advantages, there are still challenges that need further research, including clinical trials.

Composite Nanoarchitectonics of Electrospun Piezoelectric PVDF/AgNPs for Biomedical Applications, Including Breast Cancer Treatment.

This study focused on preparing composite nanomats by incorporating silver nanoparticles (AgNPs) in polyvinylidene fluoride (PVDF) nanofibers through the electrospinning process. A short review of piezoelectric PVDF-related research is presented. PVDF is known for its biocompatibility and piezoelectric properties. Since electrical signals in biological tissues have been shown to be relevant for therapeutic applications, the influence of the addition of AgNPs to PVDF on its piezoelectricity is studied, due to the ability of AgNPs to increase the piezoelectric signal, along with providing antibacterial properties. The prepared samples were characterized by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Fourier transform infrared spectroscopy. In addition, the biological activity of composites was examined using a cytotoxicity assay and an assessment of the antibacterial activity. The obtained results show that the incorporation of AgNPs into PVDF nanofibers further enhances the piezoelectricity (crystalline ß-phase fraction), already improved by the electrospinning process, compared to solution-casted samples, but only with a AgNPs/PVDF concentration of up to 0.3%; a further increase in the nanoparticles led to a ß-phase reduction. The cytotoxicity assay showed a promising effect of PVDF/AgNPs nanofibers on the MDA-MB-231 breast cancer cell line, following the non-toxicity displayed in regard to the healthy MRC-5 cell line. The antibacterial effect of PVDF/AgNPs nanofibers showed promising antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus, as a result of the Ag content. The anticancer activity, combined with the electrical properties of nanofibers, presents new possibilities for smart, multifunctional materials for cancer treatment development.

Analytical model of friction at low shear rates for soft materials in 3D printing.

BACKGROUND: The biological properties of silicone elastomers such as polydimethylsiloxane (PDMS) have widespread use in biomedicine for soft tissue implants, contact lenses, soft robots, and many other small medical devices, due to its exceptional biocompatibility. Additive manufacturing of soft materials still has significant challenges even with major advancements that have occurred in development of these technologies for customized medical devices and tissue engineering. OBJECTIVE: The aim of this study was to develop a mathematical model of tangential stress in relation to shear stress, shear rate, 3D printing pressure and velocity, for non-Newtonian gels and fluids that are used as materials for 3D printing. METHOD: This study used FENE (finitely extensible nonlinear elastic model) model, for non-Newtonian gels and fluids to define the dependences between tangential stress, velocity, and pressure, considering viscosity, shear stress and shear rates as governing factors in soft materials friction and adhesion. Experimental samples were fabricated as showcases, by SLA and FDM 3D printing technologies: elastic polymer samples with properties resembling elastic properties of PDMS and thermoplastic polyurethane (TPU) samples. Experimental 3D printing parameters were used in the developed analytical solution to analyse the relationships between governing influential factors (tangential stress, printing pressure, printing speed, shear rate and friction coefficient). Maple software was used for numerical modelling. RESULTS: Analytical model applied on a printed elastic polymer, at low shear rates, exhibited numerical values of tangential stress of 0.208-0.216 N m - 2 at printing velocities of 0.9 to 1.2 mm s - 1, while the coefficient of friction was as low as 0.09-0.16. These values were in accordance with experimental data in literature. Printing pressure did not significantly influence tangential stress, whereas it was slightly influenced by shear rate changes. Friction coefficient linearly increased with tangential stress. CONCLUSION: Simple analytical model of friction for elastic polymer in SLA 3D printing showed good correspondence with experimental literature data for low shear rates, thus indicating possibility to use it for prediction of printing parameters towards desired dimensional accuracy of printed objects. Further development of this analytical model should enable other shear rate regimes, as well as additional soft materials and printing parameters.

Application of Silicone in Ophthalmology: A Review.

This paper reviews the latest trends and applications of silicone in ophthalmology, especially related to intraocular lenses (IOLs). Silicone, or siloxane elastomer, as a synthetic polymer, has excellent biocompatibility, high chemical inertness, and hydrophobicity, enabling wide biomedical applications. The physicochemical properties of silicone are reviewed. A review of methods for mechanical and in vivo characterization of IOLs is presented as a prospective research area, since there are only a few available technologies, even though these properties are vital to ensure medical safety and suitability for clinical use, especially if long-term function is considered. IOLs represent permanent implants to replace the natural lens or for correcting vision, with the first commercial foldable lens made of silicone. Biological aspects of posterior capsular opacification have been reviewed, including the effects of the implanted silicone IOL. However, certain issues with silicone IOLs are still challenging and some conditions can prevent its application in all patients. The latest trends in nanotechnology solutions have been reviewed. Surface modifications of silicone IOLs are an efficient approach to further improve biocompatibility or to enable drug-eluting function. Different surface modifications, including coatings, can provide long-term treatments for various medical conditions or medical diagnoses through the incorporation of sensory functions. It is essential that IOL optical characteristics remain unchanged in case of drug incorporation and the application of nanoparticles can enable it. However, clinical trials related to these advanced technologies are still missing, thus preventing their clinical applications at this moment.

Thermo-Mechanical Characterization of 4D-Printed Biodegradable Shape-Memory Scaffolds Using Four-Axis 3D-Printing System.

This study was conducted on different models of biodegradable SMP (shape-memory polymer) scaffolds. A comparison was conducted utilizing a basic FDM (fused deposition modeling)/MEX (material extrusion) printer with a standard printing technique and a novel, modified, four-axis printing method with a PLA (poly lactic acid) polymer as the printing material. This way of making the 4D-printed BVS (biodegradable vascular stent) made it possible to achieve high-quality surfaces due to the difference in printing directions and improved mechanical properties-tensile testing showed a doubling in the elongation at break when using the four-axis-printed specimen compared to the regular printing, of 8.15 mm and 3.92 mm, respectfully. Furthermore, the supports created using this method exhibited a significant level of shape recovery following thermomechanical programming. In order to test the shape-memory effect, after the thermomechanical programming, two approaches were applied: one approach was to heat up the specimen after unloading it inside temperature chamber, and the other was to heat it in a warm bath. Both approaches led to an average recovery of the original height of 99.7%, while the in-chamber recovery time was longer (120 s) than the warm-bath recovery (~3 s) due to the more direct specimen heating in the latter case. This shows that 4D printing using the newly proposed four-axis printing is an effective, promising technique that can be used in the future to make biodegradable structures from SMP.

Multi-Criteria Decision Making Methods for Selection of Lightweight Material for Railway Vehicles.

This paper deals with the selection of the optimal material for railway wagons, from among three different steel and three aluminium based materials, by using four different Multicriteria Decision Making Methods (MCDM) and comparing their ranking of the materials. We analysed: Dual-Phase 600 steel, Transformation-Induced Plasticity (TRIP) 700 steel, Twinning-Induced Plasticity (TWIP) steel, Aluminium (Al) alloys, Al 6005-T6, and Al 6082-T6, and porous Al structure with closed cells. Four different MCDM methods were used: VIKOR, TOPSIS, PROMETTHEE and the Weighted aggregated sum product assessment method (WASPAS). Key material properties that were used in the MCDM analysis were: density, yield strength (Y.S.), tensile strength (T.S.), Y.S./T.S. ratio, Youngs modulus (Y.M.), cost and corrosion resistance (C.R.). Research results indicate that aluminium and its alloys prove to be the most suitable material, based on setup criteria. Advanced steels also achieved good ranking, making them a valid option, immediately behind lightweight aluminium alloys. Porous aluminium did not perform well, according to the used MDCM methods, mainly due to the significantly lower strength exhibited by the porous structures in general.

Influence of Porosity on the Mechanical Behavior during Uniaxial Compressive Testing on Voronoi-Based Open-Cell Aluminium Foam.

We have studied an application of the Voronoi tessellation method in the modeling of open-cell aluminium foam under uniaxial compressive loading. The Voronoi code was merged with computer-aided design (CAD) for converting the polyhedral model into an irregular open-cell cellular structure to create porous samples for compression testing simulations. Numerical simulations of the uniaxial compression uniformly over the upper surface of the sample in the z-axis direction at a constant 20 N load was realised. Samples with three different porosities (30%, 60% and 80%) were studied. A nonlinear elasto-plastic material model with perfect plasticity, without hardening, based on the von Mises yield criterion was applied below 10% strain. Corresponding stress⁻strain curves were observed and the influence of porosity on deformation mechanism was discussed. Samples with higher porosity exhibited significantly higher normal stress under the same load, and increased stress plateaus. An increase of porosity produced an increase of both compressive and tensile stresses and struts exhibited complex stress fields. Voronoi-based modeling was in accordance with experimental results in the literature in the case of the quasi-static condition and linear elastic region (below 1% strain). Further study is necessary to enable the simulation of real dynamic behaviour under all deformation regimes by using the Voronoi tessellation method.

Numerical Modeling and Experimental Behavior of Closed-Cell Aluminum Foam Fabricated by the Gas Blowing Method under Compressive Loading.

This paper deals with the experimental and numerical study of closed-cell aluminum-based foam under compressive loading. Experimental samples were produced by the gas blowing method. Foam samples had an average cell size of around 1 mm, with sizes in the range 0.5-5 mm, and foam density of 0.6 g/cm3. Foam samples were subjected to a uniaxial compression test, at a displacement rate of 0.001 mm/s. Load and stress were monitored as the functions of extension and strain, respectively. For numerical modeling, CT scan images of experimental samples were used to create a volume model. Solid 3D quadratic tetrahedron mesh with TETRA 10-node elements was applied, with isotropic material behavior. A nonlinear static test with an elasto-plastic model was used in the numerical simulation, with von Mises criteria, and strain was kept below 10% by the software. Uniform compressive loading was set up over the top sample surface, in the y-axis direction only. Experimental tests showed that a 90 kN load produced complete failure of the sample, and three zones were exhibited: an elastic region, a rather uniform plateau region (around 23 MPa) and a densification region that started around 35 MPa. Yielding, or collapse stress, was achieved around 20 MPa. The densification region and a rapid rise in stress began at around 52% of sample deformation. The numerical model showed both compressive and tensile stresses within the complex stress field, indicating that shear also had a prominent role. Mainly compressive stresses were exhibited in the zones of the larger cells, whereas tensile stresses occurred in zones with an increased number of small cells and thin cell walls.

Effect of vacuum-treatment on deformation properties of PMMA bone cement.

Deformation behavior of polymethyl methacrylate (PMMA) bone cement is explored using microindentation. Two types of PMMA bone cement were prepared. Vacuum treated samples were subjected to the degassing of the material under vacuum of 270 mbar for 35 s, followed by the second degassing under vacuum of 255 mbar for 35 s. Air-cured samples were left in ambient air to cool down and harden. All samples were left to age for 6 months before the test. The samples were then subjected to the indentation fatigue test mode, using sharp Vickers indenter. First, loading segment rise time was varied in order to establish time-dependent behavior of the samples. Experimental data showed that viscous part of the deformation can be neglected under the observed test conditions. The second series of microindentation tests were realized with variation of number of cycles and indentation hardness and modulus were obtained. Approximate hardness was also calculated using analysis of residual impression area. Porosity characteristics were analyzed using CellC software. Scanning electron microscopy (SEM) analysis showed that air-cured bone cement exhibited significant number of large voids made of aggregated PMMA beads accompanied by particles of the radiopaque agent, while vacuum treated samples had homogeneous structure. Air-cured samples exhibited variable hardness and elasticity modulus throughout the material. They also had lower hardness values (approximately 65-100 MPa) than the vacuum treated cement (approximately 170 MPa). Porosity of 5.1% was obtained for vacuum treated cement and 16.8% for air-cured cement. Extensive plastic deformation, microcracks and craze whitening were produced during indentation of air-cured bone cement, whereas vacuum treated cement exhibited no cracks and no plastic deformation.