Low-friction hydrophilic surface for medical devices

An insect sclerotization-inspired antifouling armor on biomedical devices combats thrombosis and embedding

Thrombus formation and tissue embedding significantly impair the clinical efficacy and retrievability of temporary interventional medical devices. Herein, we report an insect sclerotization-inspired antifouling armor for tailoring temporary interventional devices with durable resistance to protein adsorption and the following protein-mediated complications. By mimicking the phenol-polyamine chemistry assisted by phenol oxidases during sclerotization, we develop a facile one-step method to crosslink bovine serum albumin (BSA) with oxidized hydrocaffeic acid (HCA), resulting in a stable and universal BSA@HCA armor. Furthermore, the surface of the BSA@HCA armor, enriched with carboxyl groups, supports the secondary grafting of polyethylene glycol (PEG), further enhancing both its antifouling performance and durability. The synergy of robustly immobilized BSA and covalently grafted PEG provide potent resistance to the adhesion of proteins, platelets, and vascular cells in vitro. In ex vivo blood circulation experiment, the armored surface reduces thrombus formation by 95 %. Moreover, the antifouling armor retained over 60 % of its fouling resistance after 28 days of immersion in PBS. Overall, our armor engineering strategy presents a promising solution for enhancing the antifouling properties and clinical performance of temporary interventional medical devices.

Reduced Sliding Friction of Lubricant-Impregnated Catheters

During urethral catheterization, sliding friction can cause discomfort and even hemorrhaging. In this report, we use a lubricant-impregnated polydimethylsiloxane coating to reduce the sliding friction of a catheter. Using a pig urethra attached to a microforce testing system, we found that a lubricant-impregnated catheter reduces the sliding friction during insertion by more than a factor of two. This suggests that slippery, lubricant-impregnated surfaces have the potential to enhance patient comfort and safety during catheterization.

Trackability of a high-strength thromboresistant hydrogel catheter: An In vitro analysis comparing venous catheter forces in a simulated use pathway

As the need for vascular access devices (VADs) continues to increase, so does the need for innovative designs and materials that can improve placement and optimize patient outcomes. Commercially available peripherally inserted central venous catheters (PICCs) are in high demand due to their ease of use and low cost. However, they are constructed of materials that can contribute to vascular injury and result in complications such as clotting, catheter failure, and infection. This study investigated the surface and frictional properties of a HydroPICC® device constructed of a novel, inherently lubricious bulk hydrogel. Investigators posited that these materials would lower the forces required to advance and retract the HydroPICC® devices and that the measured forces are significantly lower than those of two commercially available PICCs made of conventional thermoplastic polyurethane. The HydroPICC® device had a lower insertion and retraction force compared to both the PowerPICC^TM and BioFlo^TM control devices based on an unpaired, two-sided t-test (P < .001). The HydroPICC® also exhibited a statistically significant decrease in average force when compared to both conventional PICCs (P < .001 and P = .001). When compared to PowerPICC^TM, the lubricious high-strength HydroPICC® hydrogel device exhibited an 84% ± 25% reduction in average tracking force; additionally, when compared to a fluoro-oligomer modified TPU catheter (BioFlo^TM), the HydroPICC® device exhibited a 90 ± 32% reduction in average tracking force. The HydroPICC® technology represents a new method to reduce frictional forces of implantable devices. Clinical trials are needed to determine whether the differences in frictional properties between conventional VADs and HydroPICC® devices translate into improved clinical outcomes.

Mechanism of Vascular Injury in Transcatheter Aortic Valve Replacement

The aim of the study was to determine the potential mechanism of vascular complications due to “catheter–vascular wall” interaction in transcatheter aortic valve replacement using experimental and numerical analysis.

Active agents, biomaterials, and technologies to improve biolubrication and strengthen soft tissues

Normal functioning of articulating tissues is required for many physiological processes occurring across length scales from the molecular to whole organism. Lubricating biopolymers are present natively on tissue surfaces at various sites of biological articulation, including eyelid, mouth, and synovial joints. The range of operating conditions at these disparate interfaces yields a variety of tribological mechanisms through which compressive and shear forces are dissipated to protect tissues from material wear and fatigue. This review focuses on recent advances in active agents and biomaterials for therapeutic augmentation of friction, lubrication, and wear in disease and injured states. Various small-molecule, biological, and gene delivery therapies are described, as are tribosupplementation with naturally-occurring and synthetic biolubricants and polymer reinforcements. While reintroduction of a diseased tissue's native lubricant received significant attention in the past, recent discoveries and pre-clinical research are capitalizing on concurrent advances in the molecular sciences and bioengineering fields, with an understanding of the underlying tissue structure and physiology, to afford a desired, and potentially patient-specific, tissue mechanical response for restoration of normal function. Small and large molecule drugs targeting recently elucidated pathways as well as synthetic and hybrid natural/synthetic biomaterials for restoring a desired tissue mechanical response are being investigated for treatment of, for example, keratoconjunctivitis sicca, xeroderma, and osteoarthritis.

Toward Customized Extracellular Niche Engineering: Progress in Cell-Entrapment Technologies

The primary aim in tissue engineering is to repair, replace, and regenerate dysfunctional tissues to restore homeostasis. Cell delivery for repair and regeneration is gaining impetus with our understanding of constructing tissue-like environments. However, the perpetual challenge is to identify innovative materials or re-engineer natural materials to model cell-specific tissue-like 3D modules, which can seamlessly integrate and restore functions of the target organ. To devise an optimal functional microenvironment, it is essential to define how simple is complex enough to trigger tissue regeneration or restore cellular function. Here, the purposeful transition of cell immobilization from a cytoprotection point of view to that of a cell-instructive approach is examined, with advances in the understanding of cell-material interactions in a 3D context, and with a view to further application of the knowledge for the development of newer and complex hierarchical tissue assemblies for better examination of cell behavior and offering customized cell-based therapies for tissue engineering.

Ureteral stents should be soaked for several minutes before placement

Purpose

Placement of ureteral stents (DJ-stents) may lead to complications. Inappropriate friction properties of the implant are, inter alia, made responsible for primary injuries, injury-related inflammation and a cascade of consecutive side effects. Hydrophilicity is considered to be related to low friction. The question arises, whether the various products on the market show their respective maximum hydrophilicity directly after unwrapping or a pre-use moistening, as already routinely done with the guide wire, is necessary.

Methods

The surface wettability of commercial and experimental DJ-stents was determined by water contact angle (WCA) measurements using the sessile drop method. One reference surface and 11 different stent surface types were tested. In order to determine the influence of moistening on the stents’ surface wettability, WCAs were measured twice, with dry, and soaked (30 min, 0.9%-NaCl) specimens. Each sample of a surface type was tested at three different positions to avoid effects of surface heterogeneities. Up to six samples of the same surface type were examined.

Results

Mean WCAs on fresh and soaked stent surfaces ranged from 75°–103° and 71°–99°. In every case the WCAs on soaked surfaces were lower. On average the WCAs decrease by 7%, the individual decreases differ considerably, from 2 to 16%. For 7/12 of the examined surface types, the decrease in contact angle is statistically significant with p ≤ 0.01.

Conclusions

DJ-stents freshly unwrapped show less hydrophilic properties compared to DJ-stents soaked in saline. To obtain maximum hydrophilicity at stent placement, DJ-stents should be soaked. The results may advocate a similar approach for other urological equipment.

Correlating coating characteristics with the performance of drug-coated balloons--a comparative in vitro investigation of own established hydrogel- and ionic liquid-based coating matrices

Drug-coated balloons (DCB), which have emerged as a therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficacy and safety within a number of clinical studies. In vitro studies elucidating the correlation between coating additive and DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this regard, we examined three different DCB-systems, which were developed in former studies based on the ionic liquid cetylpyridinium salicylate, the body-own hydrogel hyaluronic acid and the pharmaceutically well-established hydrogel polyvinylpyrrolidone, considering coating morphology, coating thickness, drug-loss, drug-transfer to the vessel wall, residual drug-concentration on the balloon surface and entire drug-load during simulated use in an in vitro vessel model. Moreover, we investigated particle release of the different DCB during simulated use and determined the influence of the three coatings on the mechanical behavior of the balloon catheter. We could show that coating characteristics can be indeed correlated with the performance of DCB. For instance, paclitaxel incorporation in the matrix can reduce the drug wash-off and benefit a high drug transfer. Additionally, a thin coating with a smooth surface and high but delayed solubility can reduce drug wash-off and decrease particle burden. As a result, we suggest that it is very important to characterize DCB in terms of mentioned properties in vitro in addition to their clinical efficacy in order to better understand their function and provide more data for the clinicians to improve the tool of DCB in coronary angioplasty.

Modulation of friction dynamics in water by changing the combination of the loop- and graft-type poly(ethylene glycol) surfaces

A Velcro-like poly(ethylene glycol) (PEG) interface was prepared in order to control the friction dynamics of material surfaces. Graft- and loop-type PEGs were formed on mirror-polished Ti surfaces using an electrodeposition method with mono- and di-amine functionalized PEGs. The friction dynamics of various combinations of PEG surfaces (i.e., graft-on-graft, loop-on-loop, graft-on-loop, and loop-on-graft) were investigated by friction testing. Here, only the Velcro-like combinations (graft-on-loop and loop-on-graft) exhibited a reversible friction behavior (i.e., resetting the kinetic friction coefficient and the reappearance of the maximum static friction coefficient) during the friction tests. The same tendency was observed when the molecular weights of loop- and graft-type PEGs were tested at 1 k and 10 k, respectively. This indicates that a Velcro-like friction behavior could be induced by simply changing the conformation of PEGs, which suggests a novel concept of altering polymer surfaces for the effective control of friction dynamics.

In vivo distribution of particulate matter from coated angioplasty balloon catheters

Most catheter-based vascular medical devices today have hydrophilic lubricious coatings. This study was designed to perform a territory-based downstream analysis of end organs subsequent to angioplasty with coated balloon catheters to better understand the potential in vivo physiological consequence of coating wear materials. Coronary angioplasty was performed on swine using balloon catheters modified with two polyvinylpyrrolidone (PVP)-based coatings of similar lubricity, but different levels of particulates (5-fold) when tested in a tortuous path model. Myocardial tissues examined 28 days post-angioplasty revealed no visible particulates in the animals treated with the lower particulate catheters while 3 of 40 sections from higher particulate catheters contained amorphous foreign material, and 1 of 40 sections from tissue treated with uncoated catheters had amorphous foreign material. Non-target organs and downstream muscle revealed no particulates for any of the treatments. Histological analysis showed that the overall number of vessels with embolic foreign material was low and evidence of myocyte necrosis was rare with either of the coatings investigated in this study.

Evaluation of mucoadhesive hydrogels loaded with diclofenac sodium-chitosan microspheres for rectal administration

Considering the advantageous for the rectal administration of non-steroidal anti-inflammatory drugs, the objective of this study was to formulate and evaluate rectal mucoadhesive hydrogels loaded with diclofenac-sodium chitosan (DFS-CS) microspheres. Hydroxypropyl methylcellulose (HPMC; 5%, 6%, and 7% w/w) and Carbopol 934 (1% w/w) hydrogels containing DFS-CS microspheres equivalent to 1% w/w active drug were prepared. The physicochemical characterization revealed that all hydrogels had a suitable pH for rectal application (6.5-7.4). The consistency of HPMC hydrogels showed direct proportionality to the concentration of the gelling agent, while carbopol 934 gel showed its difficulty for rectal administration. Farrow's constant for all hydrogels were greater than one indicating pseudoplastic flow. In vitro drug release from the mucoadhesive hydrogel formulations showed a controlled drug release pattern, reaching 34.6-39.7% after 6 h. The kinetic analysis of the release data revealed that zero-order was the prominent release mechanism. The mucoadhesion time of 7% w/w HPMC hydrogel was 330 min, allowing the loaded microspheres to be attached to the surface of rectal mucosa. Histopathological examination demonstrated the lowest irritant response to the hydrogel loaded with DFS-CS microspheres in response to other forms of the drug.

An optimal micropatterned end-effecter for enhancing frictional force on large intestinal surface

We present a simple surface modification method for enhancing the frictional properties on soft, viscoelastic tissue of large intestine by integrating micropatterned structures with controlled shape and geometry. The micropatterned end-effecter (EE) was fabricated onto micromachined EE body (20 mm long, 2 mm diameter cylinders) in the forms of line, box, pyramid, and bottle shape by utilizing capillary molding technique with UV-curable poly(urethane acrylate) (PUA) polymer. To evaluate the frictional behavior of micropatterned EE, we employed a biotribotester, for easy loading and test of a biological organ specimen. It was found that the frictional properties of micropatterned EE are heavily dependent upon the shape of microstructure. The patterned EE with parallel lines (to the direction of locomotion) showed better frictional performance (average frictional coefficient approximately 1.53 and maximum approximately 3.98) compared with other micropatterned EEs (average frictional coefficient 0.72-0.94 and maximum 1.78-2.49) and nonpatterned EE (average frictional coefficient approximately 0.58 and maximum approximately 1.51). In addition, various geometric parameters (e.g., height, width, and space) as well as operating conditions (e.g., contact load and sliding speed) were systematically investigated for probing optimal anchoring function of the parallel line patterned EE.

The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single-center study in 200 children

BACKGROUND

Totally implantable venous access devices (TIVAD) facilitate repeat intravenous therapy for children. Many children recover and the device may be removed. Although removal should be a simple procedure via a single incision, in our experience, this has not been the case.

METHODS

Two hundred consecutive cases of removal of TIVAD from September 2000 to January 2004 at Sophia Children's Hospital, Rotterdam, were reviewed.

RESULTS

Average patient age was 5.9 years. The commonest indication for placement was administration of chemotherapy (88%); commonest indication for removal was remission of disease (70%). The median duration in situ of the catheter was 29 months (range, 0.4-91 months). Complications with removal of the polyurethane catheter of the TIVAD were experienced in 16% of cases. To enable removal, a second incision was required in 28 patients, venotomy in 5; the catheter could not be removed in 3. For all complicated removals the catheter had been in situ for longer than 20 months.

CONCLUSIONS

Long-term implantation of TIVAD with polyurethane catheter appears unsuitable owing to a high incidence of complication at time of removal.

Effects of the chemical structure and the surface properties of polymeric biomaterials on their biocompatibility

Polymeric biomaterials have extensively been used in medicinal applications. However, factors that determine their biocompatibility are still not very clear. This article reviews various effects of the chemical structure and the surface properties of polymeric biomaterials on their biocompatibility, including protein adsorption, cell adhesion, cytotoxicity, blood compatibility, and tissue compatibility. Understanding these aspects of biocompatibility is important to the improvement of the biocompatibility of existing polymers and the design of new biocompatible polymers.

Relationship between biomedical catheter surface properties and lubricity as determined using textural analysis and multiple regression analysis

In this study, the surface properties of and work required to remove 12 commercially available and developmental catheters from a model biological medium (agar), a measure of catheter lubricity, were characterised and the relationships between these properties were examined using multiple regression and correlation analysis. The work required for removal of catheter sections (7 cm) from a model biological medium (1% w/w agar) were examined using tensile analysis. The water wettability of the catheters were characterised using dynamic contact angle analysis, whereas surface roughness was determined using atomic force microscopy. Significant differences in the ease of removal were observed between the various catheters, with the silicone-based materials generally exhibiting the greatest ease of removal. Similarly, the catheters exhibited a range of advancing and receding contact angles that were dependent on the chemical nature of each catheter. Finally, whilst the microrugosities of the various catheters differed, no specific relationship to the chemical nature of the biomaterial was apparent. Using multiple regression analysis, the relationship between ease of removal, receding contact angle and surface roughness was defined as: Work done (N mm)=17.18+0.055 Rugosity (nm)-0.52 Receding contact angle ( degrees ) (r=0.49). Interestingly, whilst the relationship between ease of removal and surface roughness was significant (r=0.48, p=0.0005), in which catheter lubricity increased as the surface roughness decreased, this was not the case with the relationship between ease of removal and receding contact angle (r=-0.18, p>0.05). This study has therefore uniquely defined the contributions of each of these surface properties to catheter lubricity. Accordingly, in the design of urethral catheters, it is recommended that due consideration should be directed towards biomaterial surface roughness to ensure maximal ease of catheter removal. Furthermore, using the method described in this study, differences in the lubricity of the various catheters were observed that may be apparent in their clinical use.

In vitro evaluation of phosphonylated low-density polyethylene for vascular applications

The use of catheters for vascular applications is often complicated by the development of friction between the catheter material and the vessel wall, which leads to endothelial cell removal and intimal lesions. Phosphonylation, a chemical surface treatment, has been proposed as a means of increasing the hydrophilicity of low-density polyethylene (LDPE), a commonly used catheter material, in efforts to impart lubricity to the material and reduce vascular tissue damage. In an in vitro tribological study, phosphonylated LDPE produced a lower coefficient of friction and allowed greater retention of endothelial cells on vessels as compared to untreated LDPE when the materials were reciprocated against normal porcine aorta. Chemical characterizations of the LDPE before and after friction testing involving Fourier transform infrared and energy-dispersive X-ray (EDX) confirmed the phosphorus content on phosphonylated LDPE. Election spectroscopy for chemical analysis (ESCA) and atomic force micrscope (AFM) analyses verified that proteins initially adsorb to both the phosphonylated and untreated LDPE surfaces and that the proteins interfere with water to lubricate the surfaces. However, with repeated friction, proteins are removed from the surface and hydrophilicity, as imparted by phosphonylation, becomes a principal factor in the lubrication process.

Elimination of stick-slip of elastomeric sutures by radiofrequency glow discharge deposited coatings

Fine elastomeric sutures intended for cardiovascular surgery can exhibit "stick-slip" behavior as they are pulled through tissue; the resulting oscillatory force can damage delicate tissue or cause sutures to snap. To eliminate this undesirable effect, sutures were surface-modified using a radiofrequency glow discharge in a vapor of either hexamethyldisiloxane or hexamethyldisilazane, to produce a thin polymeric coating on the suture. The same coatings were also deposited onto aluminized tape to facilitate their characterization by measurement of air/water contact angles and by X-ray photoelectron spectroscopy. Coatings from both monomers were found to be very hydrophobic. The hexamethyldisiloxane glow discharge coatings underwent negligible oxidation when stored in air, and thus remained stable over a shelf-life period akin to what may be required of sutures. The hexamethyldisilazane glow discharge coatings, in contrast, incorporated substantial amounts of oxygen over a 3-month period. The coatings did not measurably alter the tensile properties of the sutures. The frictional properties of coated sutures were assessed by measuring the dynamic friction between the suture and ovine myocardium. Both coatings were effective in removing the inherent stick-slip behavior of polybutester sutures in this model. The coatings remained intact after several passes and proved to be robust and efficacious under various strain regimes.

Materials and biomaterials for interventional radiology

Devices used in interventional radiology have significantly developed in the past few years. In order to understand the trends of this development, we analyzed how new interventional devices are progressively incorporating materials having original physical properties, and how developers are today progressively turning towards biomaterials, with respect to the new regulatory environment, and the requirements of biocompatibility.

A novel method to immobilize bioactive substances on hydrophobic surfaces using a polymerizable cationic lipid

We have successfully developed a novel method to stably immobilize bioactive substances that have anionic groups, such as heparin and succinylated collagen (SC), on hydrophobic surfaces through ionic complexation using a polymerizable cationic lipid, diallyl(dioleyl)ammonium bromide (DADOA). It is composed of a hydrophobic part consisting of long hydrocarbon chains and a hydrophilic head with double bonds which render it polymerizable. Analysis of the modification with DADOA and heparin suggested that the modification formed a thin layer, roughly 60 nm in thickness, as a result of the spontaneous deposition of DADOA and heparin dissolved in water, through the hydrophobic interaction between DADOA and the surface and the ionic complexation between DADOA and heparin. The heparin deposition and its rate of release in plasma were 1.5 microg/cm2 and 0.0017 U/cm2/min, respectively. Cytotoxicity test results showed that the polymerization of the deposited DADOA rendered the modified surface stable and noncytotoxic. Further, antithrombogenicity and cell attachability test results demonstrated that heparin and SC were effectively immobilized on hydrophobic surfaces through ionic complexation. This method has proved useful for the modification of the hydrophobic surfaces of medical devices because the modification process can be performed under aqueous conditions without the use of organic solvents which induce crazing/cracking of plastic casings.