Progress in the development of piezoelectric biomaterials for tissue remodeling

Piezoelectric biomaterials have demonstrated significant potential in the past few decades to heal damaged tissue and restore cellular functionalities. Herein, we discuss the role of bioelectricity in tissue remodeling and explore ways to mimic such tissue-like properties in synthetic biomaterials. In the past decade, biomedical engineers have adopted emerging functional biomaterials-based tissue engineering approaches using innovative bioelectronic stimulation protocols based on dynamic stimuli to direct cellular activation, proliferation, and differentiation on engineered biomaterial constructs. The primary focus of this review is to discuss the concepts of piezoelectric energy harvesting, piezoelectric materials, and their application in soft (skin and neural) and hard (dental and bone) tissue regeneration. While discussing the prospective applications as an engineered tissue, an important distinction has been made between piezoceramics, piezopolymers, and their composites. The superiority of piezopolymers over piezoceramics to circumvent issues such as stiffness mismatch, biocompatibility, and biodegradability are highlighted. We aim to provide a comprehensive review of the field and identify opportunities for the future to develop clinically relevant and state-of-the-art biomaterials for personalized and remote health care.

Core-Shell Structure of Photopolymer-Grafted Polyurethane as a Controlled Drug Delivery Vehicle for Biomedical Application

Functionalized ultraviolet photocurable bisphenol A-glycerolate dimethacrylates with tailorable size have been synthesized as the core, which have further been grafted using the diisocyanate chain end of polyurethane (PU) as the shell to create a core-shell structure of tunable size for a controlled drug delivery vehicle. The core-shell structure has been elucidated through spectroscopic techniques like 1H NMR, FTIR, and UV-vis and their relative shape and size through TEM and AFM morphology. The greater cross-link density of the core is reflected in the higher glass transition temperature, and the improved thermal stability of the graft copolymer is proven from its thermogravimetric analyses. The flow behavior and enhanced strength of the graft copolymers have been revealed from rheological measurements. The graft copolymer exhibits sustained release of the drug, as compared to pure polyurethane and photopolymer, arising from its core-shell structure and strong interaction between the copolymer and drug, as observed through a significant shifting of absorption peaks in FTIR and UV-vis measurements. Biocompatibility has been tested for the real application of the novel graft copolymer in medical fields, as revealed from MTT assay, cell imaging, and cell adhesion studies. The efficacy of controlled release from a graft copolymer has been verified from the gradual cell killing and ∼70% killing in 3 days vs meager cell killing of ∼25% very quickly in 1 day, followed by the increased cell viability of the system treated with the pure drug. The mechanism of slow and controlled drug release from the core-shell structure has been explored. The fluorescence images support the higher cell-killing efficiency as opposed to a pure drug or a drug embedded in polyurethane. Cells seeded on 3D scaffolds have been developed by embedding a graft copolymer, and fluorescence imaging confirms the successful growth of cells within the scaffold, realizing the potential of the core-shell graft copolymer in the biomedical arena.

Anodization as a scalable nanofabrication method to engineer mechanobactericidal nanostructures on complex geometries

Bacterial contamination of implant surfaces is one of the primary causes of their failure, and this threat has been further exacerbated due to the emergence of drug-resistant bacteria. Nanostructured mechanobactericidal surfaces that neutralize bacteria via biophysical forces instead of traditional biochemical routes have emerged as a potential remedy against this issue. Here, we report on the bactericidal activity of titania nanotubes (TNTs) prepared by anodization, a well-established and scalable method. We investigate the differences in bacterial behavior between three different topographies and demonstrate the applicability of this technique on complex three-dimensional (3D) geometries. It was found that the metabolic activity of bacteria on such surfaces was lower, indicative of disturbed intracellular processes. The differences in deformations of the cell wall of Gram-negative and positive bacteria were investigated from electron micrographs Finally, nanoindentation experiments show that the nanotubular topography was durable enough against forces typically experienced in daily life and had minimal deformation under forces exerted by bacteria. Our observations highlight the potential of the anodization technique for fabricating mechanobactericidal surfaces for implants, devices, surgical instruments, and other surfaces in a healthcare setting in a cheap, scalable way.

4D printing for biomedical applications

While three-dimensional (3D) printing excels at fabricating static constructs, it fails to emulate the dynamic behavior of native tissues or the temporal programmability desired for medical devices. Four-dimensional (4D) printing is an advanced additive manufacturing technology capable of fabricating constructs that can undergo pre-programmed changes in shape, property, or functionality when exposed to specific stimuli. In this Perspective, we summarize the advances in materials chemistry, 3D printing strategies, and post-printing methodologies that collectively facilitate the realization of temporal dynamics within 4D-printed soft materials (hydrogels, shape-memory polymers, liquid crystalline elastomers), ceramics, and metals. We also discuss and present insights about the diverse biomedical applications of 4D printing, including tissue engineering and regenerative medicine, drug delivery, in vitro models, and medical devices. Finally, we discuss the current challenges and emphasize the importance of an application-driven design approach to enable the clinical translation and widespread adoption of 4D printing.

Advanced 3D In Vitro Lung Fibrosis Models: Contemporary Status, Clinical Uptake, and Prospective Outlooks

Fibrosis has been characterized as a global health problem and ranks as one of the primary causes of organ dysfunction. Currently, there is no cure for pulmonary fibrosis, and limited therapeutic options are available due to an inadequate understanding of the disease pathogenesis. The absence of advanced in vitro models replicating dynamic temporal changes observed in the tissue with the progression of the disease is a significant impediment in the development of novel antifibrotic treatments, which has motivated research on tissue-mimetic three-dimensional (3D) models. In this review, we summarize emerging trends in preparing advanced lung models to recapitulate biochemical and biomechanical processes associated with lung fibrogenesis. We begin by describing the importance of in vivo studies and highlighting the often poor correlation between preclinical research and clinical outcomes and the limitations of conventional cell culture in accurately simulating the 3D tissue microenvironment. Rapid advancement in biomaterials, biofabrication, biomicrofluidics, and related bioengineering techniques are enabling the preparation of in vitro models to reproduce the epithelium structure and operate as reliable drug screening strategies for precise prediction. Improving and understanding these model systems is necessary to find the cross-talks between growing cells and the stage at which myofibroblasts differentiate. These advanced models allow us to utilize the knowledge and identify, characterize, and hand pick medicines beneficial to the human community. The challenges of the current approaches, along with the opportunities for further research with potential for translation in this field, are presented toward developing novel treatments for pulmonary fibrosis.

Building psychological resilience in Armed Forces worldwide

Psychological resilience among troops can be enhanced through relatively simple interventions. Globally, various Armed Forces have successfully implemented modules for building psychological resilience. Programs from different countries are listed, evaluated and their underpinnings explored. Recommendations for a variety of feasible and culturally acceptable interventions targeted at individuals, families, units, community and organizations in the Indian context have been made; ranging from mindfulness training to embedded combat psychologists. Interventions are likely to succeed if integrated within existing basic training and unit/career programs.

Smoking blunts sertraline response in depression: A prospective observational cohort study

Background

Smoking is common in patients of depression and is known to affect response to antidepressants. This study was undertaken to evaluate the effect of smoking on the antidepressant effect of sertraline.

Method

Patients with depression were divided into smoker and nonsmoker cohorts and followed up for 8 weeks. Serum sertraline levels were estimated using the high-performance liquid chromatography system. Response to treatment was evaluated with the Hamilton Depression Rating Scale (HAM-D).

Results

Serum sertraline levels did not differ between smokers and nonsmokers at 4 and 8 weeks. Nonsmokers responded better to sertraline than smokers after 8 weeks. Adverse drug reaction profile did not vary between the two groups and was not impacted by serum sertraline levels. Nonsmokers showed a greater fall in the HAM-D score than smokers.

Conclusion

This study found depression among smokers to be less responsive to sertraline. This was not explained by serum sertraline levels. Treatment of depression in smokers with sertraline might require higher doses and duration, with more frequent reviews.

Essential Role of Anisotropy in Bioengineered Cardiac Tissue Models

As regulatory bodies encourage alternatives to animal testing, there is renewed interest in engineering disease models, particularly for cardiac tissues. The aligned organization of cells in the mammalian heart controls the electrical and ionic currents and its ability to efficiently circulate blood to the body. Although the development of engineered cardiac systems is rising, insights into the topographical aspects, in particular, the necessity to design in vitro cardiac models incorporating cues for unidirectional cell growth, is lacking. This review first summarizes the widely used methods to organize cardiomyocytes (CMs) unidirectionally and the ways to quantify the resulting cellular alignment. The behavior of CMs in response to alignment is described, with emphasis on their functions and underlying mechanisms. Lastly, the limitations of state-of-the-art techniques to modulate CM alignment in vitro and opportunities for further development in the future to improve the cardiac tissue models that more faithfully mimic the pathophysiological hallmarks are outlined. This review serves as a call to action for bioengineers to delve deeper into the in vivo role of cellular organization in cardiac muscle tissue and draw inspiration to effectively mimic in vitro for engineering reliable disease models.

Visible light-based 3D bioprinted composite scaffolds of κ-carrageenan for bone tissue engineering applications

Three-dimensional (3D) printing of bone scaffolds using digital light processing (DLP) bioprinting technology empowers the treatment of patients suffering from bone disorders and defects through the fabrication of cell-laden patient-specific scaffolds. Here, we demonstrate the visible-light-induced photo-crosslinking of methacrylate-κ-carrageenan (MA-κ-CA) mixed with bioactive silica nanoparticles (BSNPs) to fabricate 3D composite hydrogels using digital light processing (DLP) printing. The 3D printing of complex bone structures, such as the gyroid, was demonstrated with high precision and resolution. DLP-printed 3D composite hydrogels of MA-κ-CA-BSNP were prepared and systematically assessed for their macroporous structure, swelling, and degradation characteristics. The viscosity, rheological, and mechanical properties were also investigated for the influence of nanoparticle incorporation in the MA-κ-CA hydrogels. The in vitro study performed with MC3T3-E1 pre-osteoblast-laden scaffolds of MA-κ-CA-BSNP revealed high cell viability, no cytotoxicity, and proliferation over 21 days with markedly enhanced osteogenic differentiation compared to neat polymeric scaffolds. Furthermore, no inflammation was observed in the 21-day study involving the in vivo examination of DLP-printed 3D composite scaffolds in a Wistar rat model. Overall, the observed results for the DLP-printed 3D composite scaffolds of MA-κ-CA and BSNP demonstrate their biocompatibility and suitability for bone tissue engineering.

Unravelling microRNA regulation and miRNA-mRNA regulatory networks in osteogenesis driven by 3D nanotopographical cues

Three-dimensional (3D) culturing of cells is being adopted for developing tissues for various applications such as mechanistic studies, drug testing, tissue regeneration, and animal-free meat. These approaches often involve cost-effective differentiation of stem or progenitor cells. One approach is to exploit architectural cues on a 3D substrate to drive cellular differentiation, which has been shown to be effective in various studies. Although extensive gene expression data from such studies have shown that gene expression patterns might differ, the gene regulatory networks controlling the expression of genes are rarely studied. In this study, we profiled genes and microRNAs (miRNAs) via next-generation sequencing (NGS) in human mesenchymal stem cells (hMSCs) driven toward osteogenesis via architectural cues in 3D matrices (3D conditions) and compared with cells in two-dimensional (2D) culture driven toward osteogenesis via soluble osteoinductive factors (OF conditions). The total number of differentially expressed genes was smaller in 3D compared to OF conditions. A distinct set of genes was observed under these conditions that have been shown to control osteogenic differentiation via different pathways. Small RNA sequencing revealed a core set of miRNAs to be differentially expressed under these conditions, similar to those that have been previously implicated in osteogenesis. We also observed a distinct regulation of miRNAs in these samples that can modulate gene expression, suggesting supplementary gene regulatory networks operative under different stimuli. This study provides insights into studying gene regulatory networks for identifying critical nodes to target for enhanced cellular differentiation and reveal the differences in physical and biochemical cues to drive cell fates.

Cellular Senescence Program is Sensitive to Physical Differences in Polymeric Tissue Scaffolds

A typical cellular senescence program involves exposing cells to DNA-damaging agents such as ionization radiation or chemotherapeutic drugs, which cause multipronged changes, including increased cell size and volume, the onset of enhanced oxidative stress, and inflammation. In the present study, we examined if the senescence onset decision is sensitive to the design, porosity, and architecture of the substrate. To address this, we generated a library of polymeric scaffolds widely used in tissue engineering of varied stiffness, architecture, and porosity. Using irradiated A549 lung cancer cells, we examined the differences between cellular responses in these 3D scaffold systems and observed that senescence onset is equally diminished. When compared to the two-dimensional (2D) culture formats, there were profound changes in cell size and senescence induction in three-dimensional (3D) scaffolds. We further establish that these observed differences in the senescence state can be attributed to the altered cell spreading and cellular interactions on these substrates. This study elucidates the role of scaffold architecture in the cellular senescence program.

Cooperative stiffening of flexible high aspect ratio nanostructures impart mechanobactericidal activity to soft substrates

Understanding how bacteria interact with surfaces with micrometer and/or sub-micrometer roughness is critical for developing antibiofouling and bactericidal topographies. A primary research focus in this field has been replicating and emulating bioinspired nanostructures on various substrates to investigate their mechanobactericidal potential. Yet, reports on polymer substrates, especially with very high aspect ratios, have been rare, despite their widespread use in our daily lives. Specifically, the role of a decrease in stiffness with an increase in the aspect ratio of nanostructures may be consequential for the mechanobactericidal mechanism, which is biophysical in nature. Therefore, this work reports on generating bioinspired high aspect ratio nanostructures on poly(ethylene terephthalate) (PET) surfaces to study and elucidate their antibacterial and antibiofouling properties. Biomimetic nanotopographies with variable aspect ratios were generated via maskless dry etching of PET in oxygen plasma. It was found that both high and low-aspect ratio structures effectively neutralized Gram-negative bacterial contamination by imparting damage to their membranes but were unable to inactivate Gram-positive cells. Notably, the clustering of the soft, flexible tall nanopillars resulted in cooperative stiffening, as revealed by the nanomechanical behavior of the nanostructures and validated with the help of finite element simulations. Moreover, external capillary forces augmented the killing efficiency by enhancing the strain on the bacterial cell wall. Finally, experimental and computational investigation of the durability of the nanostructured surfaces showed that the structures were robust enough to withstand forces encountered in daily life. Our results demonstrate the potential of the single-step dry etching method for the fabrication of mechanobactericidal topographies and their potential in a wide variety of applications to minimize bacterial colonization of soft substrates like polymers.

Emerging 4D fabrication of next-generation nerve guiding conduits: a critical perspective

The latest advancements in the field of manufacturing for biomedicine, digital health, targeted therapy, and personalized medicine have fuelled the fabrication of smart medical devices. Four-dimensional (4D) fabrication strategies, which combine the manufacturing of three-dimensional (3D) parts with smart materials and/or design, have proved beneficial in creating customized and self-fitting structures that change their properties on demand with time. These frontier techniques that yield dynamic implants can indeed alleviate various drawbacks of current clinical practices, such as the use of sutures and complex microsurgeries and associated inflammation, among others. Among various clinical applications, 4D fabrication has lately made remarkable progress in the development of next-generation nerve-guiding conduits for treating peripheral nerve injuries (PNIs) by improving the end-to-end co-aptation of transected nerve endings. The current perspective highlights the relevance of 4D fabrication in developing state-of-the-art technologies for the treatment of PNIs. Various 4D fabrication/bio-fabrication techniques for PNI treatment are summarized while identifying the challenges and opportunities for the future. Such advancements hold immense promise for improving the quality of life of patients suffering from nerve damage and the potential for extending the treatment of many other disorders. Although the techniques are being described for PNIs, they will lend themselves suitably to certain cases of cranial nerve injuries as well.

3D-Printed Materials for Wastewater Treatment

The increasing levels of water pollution pose an imminent threat to human health and the environment. Current modalities of wastewater treatment necessitate expensive instrumentation and generate large amounts of waste, thus failing to provide ecofriendly and sustainable solutions for water purification. Over the years, novel additive manufacturing technology, also known as three-dimensional (3D) printing, has propelled remarkable innovation in different disciplines owing to its capability to fabricate customized geometric objects rapidly and cost-effectively with minimal byproducts and hence undoubtedly emerged as a promising alternative for wastewater treatment. Especially in membrane technology, 3D printing enables the designing of ultrathin membranes and membrane modules layer-by-layer with different morphologies, complex hierarchical structures, and a wide variety of materials otherwise unmet using conventional fabrication strategies. Extensive research has been dedicated to preparing membrane spacers with excellent surface properties, potentially improving the membrane filtration performance for water remediation. The revolutionary developments in membrane module fabrication have driven the utilization of 3D printing approaches toward manufacturing advanced membrane components, including biocarriers, sorbents, catalysts, and even whole membranes. This perspective highlights recent advances and essential outcomes in 3D printing technologies for wastewater treatment. First, different 3D printing techniques, such as material extrusion, selective laser sintering (SLS), and vat photopolymerization, emphasizing membrane fabrication, are briefly discussed. Importantly, in this Perspective, we focus on the unique 3D-printed membrane modules, namely, feed spacers, biocarriers, sorbents, and so on. The unparalleled advantages of 3D printed membrane components in surface area, geometry, and thickness and their influence on antifouling, removal efficiency, and overall membrane performance are underlined. Moreover, the salient applications of 3D printing technologies for water desalination, oil-water separation, heavy metal and organic pollutant removal, and nuclear decontamination are also outlined. This Perspective summarizes the recent works, current limitations, and future outlook of 3D-printed membrane technologies for wastewater treatment.

Augmenting mental health literacy of troops in a large military station: A novel approach

Background

Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops.

Materials and Methods

1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months.

Results

Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months.

Conclusions

Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.

Language and executive function of clinical stage-1 HIV patients in an industrial scenario: Extent and implication

Background

Asymptomatic and mild form of the neurocognitive disorder in individuals with human immunodeficiency virus infection is still prevalent and a chief problem worldwide although the severity of the neurocognitive complications is decreasing after the introduction of combined highly active antiretroviral therapy.

Aim

To study language and executive dysfunction of HIV patients in Clinical Stage 1 in an industrial scenario in Western Maharashtra as compared to healthy controls.

Material and Methods

The Wisconsin card sorting test and Addenbrooke cognitive scale were done to check for executive function and language, respectively, and compared to age- and gender-matched HIV-negative controls.

Results

Both the results of the WCST and Addenbrooke cognitive scale showed a decline in scores in the cases as compared to the controls overall. The distribution of cases as per the gender showed no significant difference, whereas there was a significant difference as per the age.

Conclusion

In asymptomatic HIV patients, there is a decline in executive function and language as compared to the healthy controls. As most of the individuals were employed, there is a need to assess their neurocognitive function regularly as the progress of the illness can be monitored and cognitive training can be advised in these HIV-positive patients, which will not only benefit the individuals but the industrial sector in the long run as well.

Childhood trauma and bipolar affective disorder: Is there a linkage?

Bipolar affective disorder (BPAD) is a major psychiatric illness impairing the quality of life. The etiology of BPAD is influenced by different factors possibly related to gene-environment interactions. Approximately 30% to 50% of individuals with BPAD have experienced some traumatic event in childhood. Serious adverse experiences that children may suffer early in life are often described as childhood trauma (CT). It includes physical, emotional, and sexual abuse and physical and emotional neglect. CT is linked with an elevated risk of developing BPAD. Childhood adversities play a role in modulating the early onset of illness, increased number of depressive episodes, increased suicide attempts, and other clinical severity of BPAD. Hospital-based studies comprising heterogeneous populations had researched the specific role of each trauma subtype as a predisposing factor for BPAD. Identifying and addressing CT through early intervention methods may prevent the future development of chronic disorders like BPAD. This review article is an attempt to explore and highlight the existing literature regarding the association of different subtypes of CT with BPAD.

Surface nanocrystallization enhances the biomedical performance of additively manufactured stainless steel

Additive manufacturing enables the fabrication of patient-specific implants of complex geometries. Although selective laser melting (SLM) of 316L stainless steel (SS) is well established, post-processing is essential to preparing high-performance biomedical implants. The goal of this study was to investigate surface mechanical attrition treatment (SMAT) as a means to enhance the electrochemical, biomechanical, and biological performances of 316L SS fabricated by SLM in devices for the repair of bone tissues. The SMAT conditions were optimized to induce surface nanocrystallization on the additively manufactured samples. SMAT resulted in a thicker oxide layer, which provided corrosion resistance by forming a passive layer. The fretting wear results showed that the rate of wear decreased after SMAT owing to the formation of a harder nanostructured layer. Surface modification of the alloy by SMAT enhanced its ability to support the attachment and proliferation of pre-osteoblasts in vitro. The study of the response in vivo to the additively manufactured alloy in a critical-sized cranial defect murine model revealed enhanced interactions with the cellular components after the alloy was subjected to SMAT without inducing any adverse immune response. Taken together, the results of this work establish SMAT of additively manufactured metallic implants as an effective strategy for engineering next-generation, high-performance medical devices for orthopedics and craniomaxillofacial applications.

4D Printed Programmable Shape-Morphing Hydrogels as Intraoperative Self-Folding Nerve Conduits for Sutureless Neurorrhaphy

There are only a few reports of implantable 4D printed biomaterials, most of which exhibit slow deformations rendering them unsuitable for in situ surgical deployment. In this study, a hydrogel system is engineered with defined swelling behaviors, which demonstrated excellent printability in extrusion-based 3D printing and programmed shape deformations post-printing. Shape deformations of the spatially patterned hydrogels with defined infill angles are computationally predicted for a variety of 3D printed structures, which are subsequently validated experimentally. The gels are coated with gelatin-rich nanofibers to augment cell growth. 3D-printed hydrogel sheets with pre-programmed infill patterns rapidly self-rolled into tubes in vivo to serve as nerve-guiding conduits for repairing sciatic nerve defects in a rat model. These 4D-printed hydrogels minimized the complexity of surgeries by tightly clamping the resected ends of the nerves to assist in the healing of peripheral nerve damage, as revealed by histological evaluation and functional assessments for up to 45 days. This work demonstrates that 3D-printed hydrogels can be designed for programmed shape changes by swelling in vivo to yield 4D-printed tissue constructs for the repair of peripheral nerve damage with the potential to be extended in other areas of regenerative medicine.

Trends in Photopolymerizable Bioinks for 3D Bioprinting of Tumor Models

Three-dimensional (3D) bioprinting technologies involving photopolymerizable bioinks (PBs) have attracted enormous attention in recent times owing to their ability to recreate complex structures with high resolution, mechanical stability, and favorable printing conditions that are suited for encapsulating cells. 3D bioprinted tissue constructs involving PBs can offer better insights into the tumor microenvironment and offer platforms for drug screening to advance cancer research. These bioinks enable the incorporation of physiologically relevant cell densities, tissue-mimetic stiffness, and vascularized channels and biochemical gradients in the 3D tumor models, unlike conventional two-dimensional (2D) cultures or other 3D scaffold fabrication technologies. In this perspective, we present the emerging techniques of 3D bioprinting using PBs in the context of cancer research, with a specific focus on the efforts to recapitulate the complexity of the tumor microenvironment. We describe printing approaches and various PB formulations compatible with these techniques along with recent attempts to bioprint 3D tumor models for studying migration and metastasis, cell-cell interactions, cell-extracellular matrix interactions, and drug screening relevant to cancer. We discuss the limitations and identify unexplored opportunities in this field for clinical and commercial translation of these emerging technologies.

Mechanical Properties Affect Primary T Cell Activation in 3D Bioprinted Hydrogels

T cells play a critical role in the adaptive immune response of the body, especially against intracellular pathogens and cancer. In vitro, T cell activation studies typically employ planar (two-dimensional, 2D) culture systems that do not mimic native cell-to-extracellular matrix (ECM) interactions, which influence activation. The goal of this work was to study T cell responses in a cell line (EL4) and primary mouse T cells in three-dimensional (3D) bioprinted matrices of varied stiffness. Cell-laden hydrogels were 3D bioprinted from gelatin methacryloyl (GelMA) using a digital light processing (DLP)-based 3D bioprinter operated with visible light (405 nm). Mechanical characterization revealed that the hydrogels had pathophysiologically relevant stiffnesses for a lymph node-mimetic tissue construct. EL4, a mouse T cell lymphoma line, or primary mouse T cells were 3D bioprinted and activated using a combination of 10 ng/mL of phorbol myristate acetate (PMA) and 0.1 μM of ionomycin. Cellular responses revealed differences between 2D and 3D cultures and that the biomechanical properties of the 3D bioprinted hydrogel influence T cell activation. Cellular responses of the 2D and 3D cultures in a soft matrix (19.83 ± 2.36 kPa) were comparable; however, they differed in a stiff matrix (52.95 ± 1.36 kPa). The fraction of viable EL4 cells was 1.3-fold higher in the soft matrix than in the stiff matrix. Furthermore, primary mouse T cells activated with PMA and ionomycin showed 1.35-fold higher viable cells in the soft matrix than in the stiff matrix. T cells bioprinted in a soft matrix and a stiff matrix released 7.4-fold and 5.9-fold higher amounts of interleukin-2 (IL-2) than 2D cultured cells, respectively. Overall, the study demonstrates the changes in the response of T cells in 3D bioprinted scaffolds toward engineering an ex vivo lymphoid tissue-mimetic system that can faithfully recapitulate T cell activation and unravel pathophysiological characteristics of T cells in infectious biology, autoimmunity, and cancers.

Positive mental health for all serving the under-served

Mental disorders are major contributors to global burden of disease measured in Disability Adjusted Life Years (7% of all disease burden in 2017). Large treatment gaps for these disorders exist in all parts of the world. In India, overall treatment gap for mental disorders was found to be 83%. Women, children and adolescents, ethnic minorities, LGBTQ+ community, elderly and those living in remote and inaccessible areas have disproportionately higher rates of mental illness. They face unique and characteristic barriers to access to mental healthcare which increases treatment gap. These gaps have persisted despite global efforts and interventions to mitigate these barriers. Hence, there is a need to find alternatives to reduce mental health gap in these groups. Positive Mental Health interventions focuson well-being and health promoting activities, rather than on illness. The potential role of these interventions in promoting mental health and reducing treatment gap has been explored in this article.

Bioinspired nanotopography on 3D printed tissue scaffold to impart mechanobactericidal and osteogenic activities

The great demand for bone grafts has motivated the development of tissue scaffolds with osteogenic activity, whereas the risk of implant-associated infection, especially given the rise of antimicrobial resistance, has compelled the development of scaffolds with innovative antimicrobial strategies. Bioinspired mechanobactericidal nanostructures are highly appealing as an alternative to traditional chemical approaches. This study presents an innovative spin-coating setup for the generation of nanotopography on the surfaces of a three-dimensional (3D)-printed porous polylactide (PLA) scaffold based on the principle of polymer demixing. The nanostructured PLA surface exhibited excellent bactericidal activity by contact killing of P. aeruginosa (86.60 % dead cells in 24 h) and S. aureus (92.36 %). The nanoscale topography supported the attachment and proliferation of pre-osteoblasts and better supported osteogenic differentiation than the unmodified scaffold. These findings demonstrate a single-step spin coating to yield nanotopography on 3D-printed polymer scaffolds that concurrently impart mechanobactericidal and osteogenic activities. Taken together, this work has important implications for engineering the next-generation 3D printed bioactive tissue scaffolds.

Visible Light-Based 4D-Bioprinted Tissue Scaffold

Emerging four-dimensional (4D) printing strategies offer improved alternatives to conventional three-dimensional (3D)-bioprinted structures for better compliance and simplicity of application for tissue engineering. Little is reported on simple 3D-bioprinted structures prepared by digital light processing (DLP) that can change shape-to-complex constructs (4D bioprinting) in response to cell-friendly stimuli, such as hydration. In the current research work, a bioink consisting of a blend of gelatin methacryloyl (GelMA) and poly(ethylene glycol) dimethacrylate (PEGDM) with a photoinitiator and a photoabsorber was developed and printed by DLP-based 3D bioprinting operated with visible light (405 nm). The 3D-bioprinted constructs combined with differential cross-linking due to photoabsorber-induced light attenuation were leveraged to realize structural anisotropy, which led to rapid shape deformation (as low as ≈30 min) upon hydration. The sheet thickness influenced the degree of curvature, whereas the incorporation of angled strands provided control of the deformation of the 3D-printed structure. The 4D-bioprinted gels supported the viability and proliferation of cells. Overall, this study introduces a cytocompatible bioink formulation for 4D bioprinting to yield shape-morphing, cell-laden hydrogels for tissue engineering.

Impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer

Background

Mothers of children diagnosed with cancer are found to have coping difficulties in various studies. Most of the studies were done on parents after their child has been newly diagnosed with malignancy, and very few studies were done on coping skills intervention. Hence, this study has been done to assess the impact of cognitive behavioural intervention on caregiver burden in mothers of children diagnosed with cancer.

Methods

Twenty mothers coming to the outpatient department of paediatric oncology from 01 September 2018 to 30 April 2019 were enrolled for the study. The participants were administered General Health Questionnaire, Brief Coping Operation Preference Enquiry Scale, Zung Self-Rating Anxiety Scale, and Coping Inventory for Stressful Situations-21 (CISS-21) Scale. Sixteen sessions of cognitive behavioural intervention were given over 8 weeks to all the participants. Reassessment was done after 3 months by use of the above mentioned scales.

Results

Participants' mean anxiety score was 49.40 (standard deviation [SD] ±8.89). They used adaptive (active coping and positive reframing) more than the maladaptive (denial and self-blame) coping strategies. Task- and emotion-focused coping mean score on CISS-21 revealed 19.25 (SD ±6.20) and 18.90 (SD ±5.76), respectively. Reassessment after cognitive behavioural intervention revealed statistically significant improvement in maladaptive coping styles, mean anxiety index score, avoidance, and emotion-focused coping.

Conclusion

The study has revealed mild to moderate anxiety and the use of both adaptive and maladaptive coping strategies by participants. There is statistically significant improvement in anxiety, maladaptive coping strategies with cognitive behavioural intervention.

Mechanobactericidal Nanotopography on Nitrile Surfaces toward Antimicrobial Protective Gear

We have much to learn from other living organisms when it comes to engineering strategies to combat bacterial infections. This study describes the fabrication of cicada wing-inspired nanotopography on commercially pure (CP) nitrile sheets and nitrile gloves for medical use using the reactive ion etching (RIE) technique. Antibacterial activity against P. aeruginosa was tested using two different surface morphologies. It was observed that the etched nitrile surfaces effectively minimized bacterial colonization by inducing membrane damage. Our findings demonstrate a single-step dry etching method for creating mechanobactericidal topographies on nitrile-based surfaces. These findings have utility in designing next-generation personal protective gear in the clinical setting and for many other important applications in the age of antimicrobial resistance.

Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial

BACKGROUND

Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT.

METHODS

TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890).

FINDINGS

From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64).

INTERPRETATION

In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT.

FUNDING

Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.

Wire Arc Additive Manufacturing of Zinc as a Degradable Metallic Biomaterial

Wire arc additive manufacturing (WAAM) offers a high rate of material deposition among various additive manufacturing techniques with wire as feedstock material but has not been established for zinc alloys. Zn alloys can be used as degradable biomaterials, in contrast to conventional permanent metallic biomaterials. In this work, commercially pure Zn was processed by WAAM to obtain near-dense parts, and the properties obtained through WAAM-processed Zn were compared with wrought (WR) Zn samples. The microstructure and hardness values of the WAAM (41 ± 1 HV0.3) components were found to be similar to those of the WR (35 ± 2 HV0.3) components. Bulk X-ray diffraction texture measurements suggested that WAAM builds exhibit a heavily textured microstructure compared to the WR counterparts, with peak intensities around <3 3−6 2> or <0 0 0 2> in the directions parallel to the build direction (BD). The corrosion rates in simulated body fluid (SBF) were similar for WAAM (0.45 mmpy) and WR (0.3 mmpy) samples. The weight loss measurements in SBF were found to be marginally higher in the WAAM samples compared to the WR counterparts for a duration of up to 21 days. MC3T3-E1 preosteoblasts were found to be healthy and proliferating in the culture medium containing the degradation products from WAAM-Zn in a manner similar to WR-Zn. This work establishes the feasibility of processing Zn by WAAM for use in bioresorbable metallic implants.

Injectable Adhesive Hydrogels for Soft tissue Reconstruction: A Materials Chemistry Perspective

Injectable bioadhesives offer several advantages over conventional staples and sutures in surgery to seal and close incisions or wounds. Despite the growing research in recent years few injectable bioadhesives are available for clinical use. This review summarizes the key chemical features that enable the development and improvements in the use of polymeric injectable hydrogels as bioadhesives or sealants, their design requirements, the gelation mechanism, synthesis routes, and the role of adhesion mechanisms and strategies in different biomedical applications. It is envisaged that developing a deep understanding of the underlying materials chemistry principles will enable researchers to effectively translate bioadhesive technologies into clinically-relevant products.

Casein-Coated Molybdenum Disulfide Nanosheets Augment the Bioactivity of Alginate Microspheres for Orthopedic Applications

Defects and disorders of the bone due to disease, trauma, or abnormalities substantially affect a person's life quality. Research in bone tissue engineering is motivated to address these clinical needs. The present study demonstrates casein-mediated liquid exfoliation of molybdenum disulfide (MoS₂) and its coupling with alginate to create microspheres to engineer bone graft substitutes. Casein-exfoliated nano-MoS₂ was chemically characterized using different analytical techniques. The UV-visible spectrum of nano-MoS₂-2 displayed strong absorption peaks at 610 and 668 nm. In addition, the XPS spectra confirmed the presence of the molybdenum (Mo, 3d), sulfur (S, 2p), carbon (C, 1s), oxygen (O, 1s), and nitrogen (N, 1s) elements. The exfoliated MoS₂ nanosheets were biocompatible with the MG-63, MC3T3-E1, and C2C12 cells at 250 μg/mL concentration. Further, microspheres were created using alginate, and they were characterized physiochemically and biologically. Stereomicroscopic images showed that the microspheres were spherical with an average diameter of 1 ± 0.2 mm. The dispersion of MoS₂ in the alginate matrix was uniform. The alginate-MoS₂ microspheres promoted apatite formation in the SBF (simulated body fluid) solution. Moreover, the alginate-MoS₂ was biocompatible with MG-63 cells and promoted cell proliferation. Higher alkaline phosphatase activity and mineralization were observed on the alginate-MoS₂ with the MG-63 cells. Hence, the developed alginate-MoS₂ microsphere could be a potential candidate for a bone graft substitute.

Common polymorphisms of protein tyrosine phosphate non-receptor type 2 gene are not associated with risk of Crohn’s disease in Indian

BACKGROUND

Multiple genetic risk factors for Crohn’s disease (CD) have been identified. However, these observations are not consistent across different populations. The protein tyrosine phosphate non-receptor type 2 (PTPN2) gene plays a role in various aspects of host defense including epithelial barrier function, autophagy, and innate and adaptive immune response. Two common polymorphisms in the PTPN2 gene (rs2542151 and rs7234029) have been associated with risk of CD in Western countries.

AIM

To evaluate the association of PTPN2 gene polymorphisms with risk of CD in Indian population.

METHODS

We conducted a prospective case-control study. Patients with CD were recruited, and their clinical and investigation details were noted. Controls were patients without organic gastrointestinal disease or other comorbid illnesses. Two common polymorphisms in the PTPN2 gene (rs2542151 and rs7234029) were assessed. DNA was extracted from peripheral blood samples of cases and controls and target DNA was amplified using specific sets of primers. The amplified fragments were digested with restriction enzymes and the presence of polymorphism was detected by restriction fragment length polymorphism. The frequency of alleles was determined. The frequencies of genotypes and alleles were compared between cases and controls to look for significant differences.

RESULTS

A total of 108 patients with CD (mean age 37.5 ± 12.7 years, females 42.6%) and 100 controls (mean age 39.9 ± 13.5 years, females 37%) were recruited. For the single nucleotide polymorphism (SNP) rs7234029, the overall frequency of G variant genotype (AG or GG) was noted to be significantly lower in the cases compared to controls (35.2% vs 50%, P = 0.05). For the SNP rs2542151, the overall frequency of G variant genotype (GT or GG) was noted to be similar in cases compared to controls (43.6% vs 47%, P = 0.73). There were no significant differences in minor allele (G) frequency for both polymorphisms between the cases and controls. Both the SNPs had no significant association with age of onset of illness, gender, disease location, disease behaviour, perianal disease, or extraintestinal manifestations of CD.

CONCLUSION

Unlike observation form the West, polymorphisms in the PTPN2 gene (rs7234029 and rs2542151) are not associated with an increased risk of developing CD in Indian patients.

Resection of Osteoid Osteoma Using Three-Dimensional (3D) Printing

Using computed tomography scans, we were able to treat symptomatic osteoid osteoma of the distal radius with the help of 3D printing technology that involves designing bone models and fabricating surgical guides to locate the tumour precisely and resect it successfully with limited exposure without the use of any intraoperative imaging. This is a new technology that can be applied to treat bony lesions and can be an alternative solution to currently available techniques.

Cognitive behavior therapy as an adjuvant in management of alcohol dependence syndrome

BACKGROUND

Treatment of alcohol dependence is a major challenge due to frequent relapses. Cognitive-behavioral therapy (CBT) has been reported to be useful in the treatment of alcohol dependence.

AIM

This study aims to evaluate the effect of CBT module in management of Alcohol Dependence and compare it with treatment as usual (TAU).

MATERIALS AND METHODS

All newly diagnosed alcohol dependence patients during the study period meeting the exclusion and inclusion criteria were included in the study. Patients with a head injury, HIV seropositive status, or any other organic brain disorder and comorbid psychiatric disorders were excluded. The study included 226 patients with alcohol dependence randomly assigned to intervention group (n = 116) and TAU group (n = 110). Demographic and clinical data were recorded and Severity of Alcohol Dependence Questionnaire was applied. Relapse was taken as an outcome variable. Both TAU group and experimental group were followed on standard protocol of treatment.

RESULTS

The data were analyzed and relative risk (RR) was calculated. Findings revealed the study group receiving CBT had a better outcome and relapse rate was also significantly low in the experimental group as compared to the TAU group.

CONCLUSION

The RR of relapse is lower in patients of alcohol dependence on CBT within 6 months and within 1 year as compared to cases on TAU. It is recommended that CBT be used as an adjunct to treatment in alcohol dependence cases.

Adding pre-emptive anticholinergics to antipsychotics: Is it justified?

Anti-psychotics are the mainstay of treatment for Schizophrenia and psychotic disorders. Historically, anticholinergics have been prescribed to prevent or treat extrapyramidal side effects (EPS) associated with first-generation antipsychotics (FGAs). Even though newer antipsychotics are associated with markedly lower rates of EPS, concurrent anticholinergic use remains high. Use of these medications has potential for long-term side effects, worsening of EPS and poor adherence. We have briefly discussed the limited association between second-generation antipsychotics (SGAs) and EPS, the efficacy of anticholinergics for different types of EPS, and summarized various national and international guidelines on the subject. In conclusion, there is no evidence for prophylactic use of anticholinergics with antipsychotics. Clinicians need to guard against this tendency to be unduly cautious.

Strategies to Promote Vascularization in 3D Printed Tissue Scaffolds: Trends and Challenges

Three-dimensional (3D) printing techniques for scaffold fabrication have shown promising advancements in recent years owing to the ability of the latest high-performance printers to mimic the native tissue down to submicron scales. Nevertheless, host integration and performance of scaffolds in vivo have been severely limited owing to the lack of robust strategies to promote vascularization in 3D printed scaffolds. As a result, researchers over the past decade have been exploring strategies that can promote vascularization in 3D printed scaffolds toward enhancing scaffold functionality and ensuring host integration. Various emerging strategies to enhance vascularization in 3D printed scaffolds are discussed. These approaches include simple strategies such as the enhancement of vascular in-growth from the host upon implantation by scaffold modifications to complex approaches wherein scaffolds are fabricated with their own vasculature that can be directly anastomosed or microsurgically connected to the host vasculature, thereby ensuring optimal integration. The key differences among the techniques, their pros and cons, and the future opportunities for utilizing each technique are highlighted here. The Review concludes with the current limitations and future directions that can help 3D printing emerge as an effective biofabrication technique to realize tissues with physiologically relevant vasculatures to ultimately accelerate clinical translation.

Anisotropy of Additively Manufactured Co-28Cr-6Mo Influences Mechanical Properties and Biomedical Performance

Additive manufacturing (AM) of biomedical alloys such as Co-Cr-Mo alloys holds immense potential for fabricating implants with complex geometry and tailored to meet patient-specific needs. However, layer-by-layer fabrication in AM processes results in undesired anisotropy due to the solidification texture and grain morphology. The present study aimed to investigate the effect of build orientation on the mechanical properties and functional performance, including tribocorrosion behavior and cytocompatibility of an orthopedic Co-28Cr-6Mo alloy manufactured by selective laser melting. Although the fabricated alloy showed weak crystallographic texture due to the rotational scanning strategy, significant anisotropy was found in the tensile properties due to the grain size and morphology. The presence of larger, elongated grains along the build direction as compared to smaller, equiaxed grains perpendicular to the build direction imparted the observed tensile anisotropy. Quantitative analysis based on current models for strengthening mechanisms is insufficient to explain the observed anisotropy, which is ascribed to the possible role of the cellular dendrites and stacking fault strengthening in Co-Cr alloys. Unlike the electrochemical behavior, which was largely independent of the build orientation, the bio-tribocorrosion studies revealed an anisotropic wear rate under fretting conditions. Osteoblast attachment and proliferation were found to be higher on the plane perpendicular to the build direction, owing to the differences in grain size. This work provides novel insights into the role of the manufacturing parameters in a selective-laser-melted Co-Cr alloy and its potential application in engineering load-bearing orthopedic implants.

Light-based 3D bioprinting of bone tissue scaffolds with tunable mechanical properties and architecture from photocurable silk fibroin

Three-dimensional (3D) bioprinting based on digital light processing (DLP) offers unique opportunities to prepare scaffolds that mimic the architecture and biomechanical properties of human tissues. Limited availability of biocompatible and biodegradable bioinks amenable for DLP-bioprinting is an impediment in this field. This study presents a bioink prepared from silk fibroin (SF) tailored for DLP bioprinting. Photocurable methacrylated-SF (SF-MA) was synthesized with 67.3% of methacrylation. Physical characterization of rheological and mechanical properties revealed that the 3D printed hydrogels of SF-MA (spanning from 10 to 25 wt%) exhibit bone tissue-like viscoelastic behavior and compressive modulus ranging from ≈12 kPa to ≈96 kPa. The gels exhibited favorable degradation (≈48 to 91% in 21 days). This SF-MA bioink afforded the printing of complex structures, with high precision. Pre-osteoblasts were successfully encapsulated in 3D bioprinted SF-MA hydrogels with high viability. 15% SF-MA DLP bioprinted hydrogels efficiently supported cell proliferation with favorable cell morphology and cytoskeletal organization. A progressive increase in cell-mediated calcium deposition up to 14 days confirmed the ability of the gels to drive osteogenesis, which was further augmented by soluble induction factors. This work demonstrates the potential of silk fibroin-derived bioinks for DLP-based 3D bioprinting of scaffolds for tissue engineering.

Laser Powder Bed Fusion Additive Manufacturing of a Low-Modulus Ti-35Nb-7Zr-5Ta Alloy for Orthopedic Applications

Laser powder bed fusion (L-PBF) was attempted here to additively manufacture a new generation orthopedic β titanium alloy Ti-35Nb-7Zr-5Ta toward engineering patient-specific implants. Parts were fabricated using four different values of energy density (ED) input ranging from 46.6 to 54.8 J/mm³ through predefined laser beam parameters from prealloyed powders. All the conditions yielded parts of >98.5% of theoretical density. X-ray microcomputed tomography analyses of the fabricated parts revealed minimal imperfections with enhanced densification at a higher ED input. X-ray diffraction analysis indicated a marginally larger d-spacing and tensile residual stress at the highest ED input that is ascribed to the steeper temperature gradients. Cellular to columnar dendritic transformation was observed at the highest ED along with an increase in the size of the solidified features indicating the synergetic effects of the temperature gradient and solidification growth rate. Density measurements indicated ≈99.5% theoretical density achieved for an ED of 50.0 J/mm³. The maximum tensile strength of ≈660 MPa was obtained at an ED of 54.8 J/mm³ through the formation of the columnar dendritic substructure. High ductility ranging from 25 to 30% was observed in all the fabricated parts irrespective of ED. The assessment of cytocompatibility in vitro indicated good attachment and proliferation of osteoblasts on the fabricated samples that were similar to the cell response on commercially pure titanium, confirming the potential of the additively manufactured Ti-35Nb-7Zr-5Ta as a suitable material for biomedical applications. Taken together, these results demonstrate the feasibility of L-PBF of Ti-35Nb-7Zr-5Ta for potentially engineering patient-specific orthopedic implants.

Emerging Trends in Biliary Stents: A Materials and Manufacturing Perspective

Biliary stent technology has come a long way since its inception. There have been significant advancements in materials used, designs, and deployment strategies. Options have expanded from thermoplastic and metallic...

Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do?

BACKGROUND

Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio.

METHODOLOGY

Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio.

RESULTS

One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable.

CONCLUSION

It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.

Surface Decoration of Redox-Modulating Nanoceria on 3D-Printed Tissue Scaffolds Promotes Stem Cell Osteogenesis and Attenuates Bacterial Colonization

Oxidative stress at the bone defect site delays the bone regeneration process. Increased level of reactive oxygen species (ROS) is the primary cause of oxidative stress at the damaged site. Bone tissue scaffolds that scavenge ROS offer a potential and yet unexplored route for faster bone healing. Cerium oxide (ceria) is known for its redox-modulating behavior. Three-dimensional (3D)-printed porous scaffolds fabricated from degradable polymers provide a physical microenvironment but lack the bioactivity for tissue regeneration. In this work, porous poly(lactic acid) (PLA) scaffolds were prepared by 3D printing and modified with poly(ethylene imine) and citric acid to decorate with ceria nanoparticles. Scanning electron micrographs revealed a macroporous architecture decorated with ceria particles. The compressive modulus of 27 MPa makes them suitable for trabecular bone. The scaffolds supported human mesenchymal stem cell growth, confirming cytocompatibility. The ability to scavenge ROS confirmed that surface functionalization with ceria could reduce oxidative stress levels in the cells. Stem cell osteogenesis was enhanced after ceria decoration of the PLA scaffolds. Transcriptional profiling studied by sequencing revealed changes in the expression of genes associated with inflammation and cell-material interactions. The ceria-functionalized scaffolds show enhanced antibacterial activity against both Gram-negative and Gram-positive bacterial strains. These results demonstrate that surface decoration with nanoceria offers a viable route for enhancing the bioactivity of 3D-printed PLA scaffolds for bone tissue regeneration with ROS scavenging and antibacterial capability.

Electrophoretic Deposition of Nanocrystalline Calcium Phosphate Coating for Augmenting Bioactivity of Additively Manufactured Ti-6Al-4V

Additive manufacturing (AM) is being widely explored for engineering biomedical implants. The microstructure and surface finish of additively manufactured parts are typically different from wrought parts and exhibit limited bioactivity despite the other advantages of using AM for fabrication. The aim of this study was to enhance the bioactivity of selective laser melted Ti-6Al-4V alloy by electrophoretic deposition of nanohydroxyapatite (nanoHAp) coatings. The deposition parameters were systematically investigated after the coatings were deposited on the as-manufactured surface or after polishing the surface of the additively-manufactured sample. The surfaces were coated with nanoHAp suspended in either ethanol or butanol using different voltages (10, 30, or 50 V) for varied deposition times. The formation of the nanoHAp coating was confirmed by Fourier-transform infrared spectroscopy and X-ray diffraction. Microstructural analysis revealed that several conditions of the coating led to crack formation. The coated samples were subsequently heat-treated to improve the integrity of the coating. Heat treatment led to crack formation in several conditions due to thermal shrinkages. Coatings prepared using butanol were more uniform and had minimal cracks compared with the use of ethanol. Nanoindentation confirmed good stability and integrity of the nanoHAP coatings on the as-manufactured and polished surfaces. The coating on the as-manufactured sample exhibited higher hardness and lower elastic modulus as compared with the coating on the polished sample. In vitro study revealed that the nanoHAp coating markedly enhanced the attachment, proliferation, and differentiation of preosteoblasts on the alloy. These results provide a viable route to enhancing the bioactivity through deposition of nanoHAp with important implications for engineering additively manufactured orthopedic and dental implants suitable for better clinical performance.