Melt blending of poly(lactic acid) with biomedically relevant polyurethanes to improve mechanical performance

Minimally invasive surgery procedures are of utmost relevance in clinical practice. However, the associated mechanical stress on the material poses a challenge for new implant developments. In particular PLLA, one of the most widely used polymeric biomaterials, is limited in its application due to its high brittleness and low elasticity. In this context, blending is a conventional method of improving the performance of polymer materials. However, in implant applications and development, material selection is usually limited to the use of medical grade polymers. The focus of this work was to investigate the extent to which blending poly-l-lactide (PLLA) with low contents of a selection of five commercially available medical grade polyurethanes leads to enhanced material properties. The materials obtained by melt blending were characterized in terms of their morphology and thermal properties, and the mechanical performance of the blends was evaluated taking into account physiological conditions. From these data, we found that mixing PLLA with Pellethane 80A is a promising approach to improve the material's performance, particularly for stent applications. It was found that PLLA/Pellethane blend with 10% polyurethane exhibits considerable plastic deformation before fracture, while pure PLLA fractures with almost no deformation. Furthermore, the addition of Pellethane only leads to a moderate reduction in elongation at yield and yield stress. In addition, dynamic mechanical analysis for three different PLLA/Pellethane ratios was performed to investigate thermally induced shape retention and shape recovery of the blends.

Revisiting SFA stent technology: an updated overview on mechanical stent performance

OBJECTIVES

The study investigated mechanical parameters of stent systems indicated for treatment of femoropopliteal (FP) arterial disease to support interpretation of clinical results and the related causalities.

METHODS

Eight stent system types of same dimensions were investigated (n=2). Parameters were the profile of stent delivery system (SDS), radiopacity, trackability and pushability, bending stiffness (flexibility) and axial stiffness of expanded stents, length change during expansion, radial force, crush resistance, strut thickness and general surface condition.

RESULTS

The trackability ranged from 0.237 to 0.920 N and the pushability was 47.9-67.6 %. The bending stiffness of SDS was between 108.42 and 412.68 N mm2. The length change during stent release to 5 mm was low, with one exception. The bending stiffness of the expanded stents was 2.73-41.67 N mm2. The normalized radial forces at 5 mm diameter ranged from 0.133 N/mm to 0.503 N/mm. During non-radial compression by 50 %, the forces were 3.07-8.42 N, with one exception (58.7 N). The strut thickness was 153-231 µm.

CONCLUSIONS

Large differences occurred for flexibility, radial force and length change during expansion. The data should be used when choosing the proper device for restoring vascular function.

Fetuin A functionalisation of biodegradable PLLA-co-PEG nonwovens towards enhanced biomineralisation and osteoblastic growth behaviour

Therapy for large-scale bone defects remains a major challenge in regenerative medicine. In this context, biodegradable electrospun nonwovens are a promising material to be applied as a temporary implantable scaffold as their fibre diameters are in the micro- and nanometre range and possess a high surface-to-volume ratio paired with high porosity. In this work, in vitro assessment of biodegradable PLLA-co-PEG nonwovens with fetuin A covalently anchored to the surface has been performed in terms of biomineralisation and the influence on MG-63 osteoblast cell metabolic activity, biosynthesis of type I collagen propeptide and inflammatory potential. Our finding was that covalent fetuin A funtionalisation of the nonwoven material leads to a distinct increase in calcium affinity, thus enhancing biomineralisation while maintaining the distinct fibre morphology of the nonwoven. The cell seeding experiments showed that the fetuin A functionalised and subsequently in vitro biomineralised PLLA-co-PEG nonwovens did not show negative effects on MG-63 growth. Fetuin A funtionalisation and enhanced biomineralisation supported cell attachment, leading to improved cell morphology, spreading and infiltration into the material. Furthermore, no signs of increase in the inflammatory potential of the material have been detected by flow cytometry experiments. Overall, this study provides a contribution towards the development of artificial scaffolds for guided bone regeneration with the potential to enhance osteoinduction and osteogenesis.

Investigation of Stent Prototypes for the Eustachian Tube in Human Donor Bodies

Chronic otitis media is often connected to Eustachian tube dysfunction. As successful treatment cannot be guaranteed with the currently available options, the aim is to develop a stent for the Eustachian tube (ET). Over the course of this development, different prototypes were generated and tested in ex vivo experiments. Four different prototypes of an ET stent and one commercially available coronary stent were implanted in the ET of seven human donor bodies. The position of the stents was verified by cone beam CT. The implanted ETs were harvested, embedded in resin and ground at 200 µm steps. Resulting images of the single steps were used to generate 3D models. The 3D models were then evaluated regarding position of the stent in the ET, its diameters, amount of squeezing, orientation of the axes and other parameters. Virtual reconstruction of the implanted ET was successful in all cases and revealed one incorrect stent placement. The cross-section increased for all metal stents in direction from the isthmus towards the pharyngeal orifice of the ET. Depending on the individual design of the metal stents (open or closed design), the shape varied also between different positions along a single stent. In contrast, the cross-section area and shape remained constant along the polymeric prototype. With the current investigation, insight into the behavior of different prototypes of ET stents was gained, which can help in defining the specifications for the intended ET stent.

Micro Injection Molding of Drug-Loaded Round Window Niche Implants for an Animal Model Using 3D-Printed Molds

A novel approach for the long-term medical treatment of the inner ear is the diffusion of drugs through the round window membrane from a patient-individualized, drug-eluting implant, which is inserted in the middle ear. In this study, drug-loaded (10 wt% Dexamethasone) guinea pig round window niche implants (GP-RNIs, ~1.30 mm × 0.95 mm × 0.60 mm) were manufactured with high precision via micro injection molding (µIM, T_mold = 160 °C, crosslinking time of 120 s). Each implant has a handle (~3.00 mm × 1.00 mm × 0.30 mm) that can be used to hold the implant. A medical-grade silicone elastomer was used as implant material. Molds for µIM were 3D printed from a commercially available resin (T_G = 84 °C) via a high-resolution DLP process (xy resolution of 32 µm, z resolution of 10 µm, 3D printing time of about 6 h). Drug release, biocompatibility, and bioefficacy of the GP-RNIs were investigated in vitro. GP-RNIs could be successfully produced. The wear of the molds due to thermal stress was observed. However, the molds are suitable for single use in the µIM process. About 10% of the drug load (8.2 ± 0.6 µg) was released after 6 weeks (medium: isotonic saline). The implants showed high biocompatibility over 28 days (lowest cell viability ~80%). Moreover, we found anti-inflammatory effects over 28 days in a TNF-α-reduction test. These results are promising for the development of long-term drug-releasing implants for human inner ear therapy.

Detection of acoustic emission from nanofiber nonwovens under tensile strain - An ultrasonic test setup for critical medical device components

In the biomedical field, nanofiber materials are gaining increasing application. For material characterization of nanofiber fabrics, tensile testing and scanning electron microscopy (SEM) are established standards. However, tensile tests provide information about the entire sample without information about single fibers. Conversely, SEM images examine individual fibers, but cover only a small section near the surface of the sample. To gain information on failure at the fiber level under tensile stress, recording of acoustic emission (AE) is a promising method, but challenging due to weak signal intensity. Using AE recording, beneficial findings can be obtained even on "invisible" material failure without affecting tensile tests. In this work, a technology for recording weak ultrasonic AE of tearing nanofiber nonwovens is presented, which uses a highly sensitive sensor. Functional proof of the method using biodegradable PLLA nonwoven fabrics is provided. The potential benefit is demonstrated by unmasking significant AE intensity in an almost imperceptible bend in the stress-strain curve of a nonwoven fabric. AE recording has not yet been performed on standard tensile tests of unembedded nanofiber material intended for safety-related medical applications. The technology has the potential to enrich the spectrum of testing methods, even those not confined to medical field.

Influence of PEGDA Molecular Weight and Concentration on the In Vitro Release of the Model Protein BSA-FITC from Photo Crosslinked Systems

Novel 3D printing techniques enable the development of medical devices with drug delivery systems that are tailored to the patient in terms of scaffold shape and the desired pharmaceutically active substance release. Gentle curing methods such as photopolymerization are also relevant for the incorporation of potent and sensitive drugs including proteins. However, retaining the pharmaceutical functions of proteins remains challenging due to the possible crosslinking between the functional groups of proteins, and the used photopolymers such as acrylates. In this work, the in vitro release of the model protein drug, albumin-fluorescein isothiocyanate conjugate (BSA-FITC) from differently composed, photopolymerized poly(ethylene) glycol diacrylate (PEGDA), an often employed, nontoxic, easily curable resin, was investigated. Different PEGDA concentrations in water (20, 30, and 40 wt %) and their different molecular masses (4000, 10,000, and 20,000 g/mol) were used to prepare a protein carrier with photopolymerization and molding. The viscosity measurements of photomonomer solutions revealed exponentially increasing values with increasing PEGDA concentration and molecular mass. Polymerized samples showed increasing medium uptake with an increasing molecular mass and decreasing uptake with increasing PEGDA content. Therefore, the modification of the inner network resulted in the most swollen samples (20 wt %) also releasing the highest amount of incorporated BSA-FITC for all PEGDA molecular masses.

Development of a Novel Valve-Controlled Drug-Elutable Microstent for Microinvasive Glaucoma Surgery: In Vitro and Preclinical In Vivo Studies

Purpose

Microinvasive glaucoma surgery (MIGS) has become an important treatment approach for primary open-angle glaucoma, although the safe and long-term effective lowering of intraocular pressure with currently available implants for MIGS is not yet achieved to a satisfactory extent. The study focusses on the development and in vitro and in vivo testing of a novel microstent for MIGS.

Methods

A silicone elastomer-based microstent was developed. Implants were manufactured using dip coating, fs-laser cutting, and spray coating. Within the current study no antifibrotic drug was loaded into the device. Sterilized microstents were analyzed in vitro regarding pressure-flow characteristics and biocompatibility. Six New Zealand white rabbits were implanted with a microstent draining the aqueous humor from the anterior chamber into the subconjunctival space. Drainage efficacy was evaluated using oculopressure tonometry as a transient glaucoma model. Noninvasive imaging was performed.

Results

Microstents were manufactured successfully and characterized in vitro. Implantation in vivo was successful for four animals with additional device fixation. Without additional fixation, dislocation of microstents was found in two animals. Safe and effective intraocular pressure reduction was observed for the four eyes with correctly implanted microstent during the 6-month trial period.

Conclusions

The described microstent represents an innovative treatment approach for MIGS. The incorporation of a selectively antifibrotic drug into the microstent drug-elutable coating will be addressed in future investigations.

Translational Relevance

The current preclinical study successfully provided proof of concept for our microstent for MIGS which is suitable for safe and effective intraocular pressure reduction and offers promising perspectives for the clinical management of glaucoma.

Novel dalbavancin-PLLA implant coating prevents hematogenous Staphylococcus aureus infection in a minimally invasive mouse tail vein model

Infective/bacterial endocarditis is a rare but life-threatening disease with a hospital mortality rate of 22.7% and a 1-year mortality rate of 40%. Therefore, continued research efforts to develop efficient anti-infective implant materials are of the utmost importance. Equally important is the development of test systems that allow the performance of new materials to be comprehensively evaluated. In this study, a novel antibacterial coating based on dalbavancin was tested in comparison to rifampicin/minocycline, and the suitability of a recently developed mouse tail vein model for testing the implant coatings was validated. Small polymeric stent grafts coated with a poly-L-lactic acid (PLLA) layer and incorporated antibiotics were colonized with Staphylococcus (S.) aureus before implantation into the tail vein of mice. The main assessment criteria were the hematogenous spread of the bacteria and the local tissue reaction to the contaminated implant. For this purpose, colony-forming units (CFU) in the blood, spleen and kidneys were determined. Tail cross sections were prepared for histological analysis, and plasma cytokine levels and expression values of inflammation-associated genes were examined. Both antibiotic coatings performed excellently, preventing the onset of infection. The present study expands the range of available methods for testing the anti-infectivity of cardiovascular implants, and the spectrum of agents for effective surface coating.

In vitro biostability of cardiac pacemaker lead insulations under static mechanical loading

Patients with cardiac arrhythmias are currently treated with conventional transvenous rhythm implants. Complications are frequently associated with intracardiac implanted leads primary insulated by silicone and polyurethane. However, experiences show that polyurethanes in particular are susceptible to various degradation mechanisms including hydrolysis, environmental stress cracking (ESC) and metal ion induced oxidation (MIO). In vivo, pacemaker leads are exposed to a complex thermal, chemical, mechanical and biological loading. The current study focusses on in vitro analyses to assess the biostability of Pellethane 2363 55D and the silicone MED 4765 as cardiac pacemaker lead insulations. Degradation processes were simulated in vitro in a load-free state and under static mechanical loading by subjecting a coaxial lead design to bending radii from 3 mm to 19 mm. Physiological environmental conditions were mimicked using a physiological saline solution and a tempered oxidative solution. Surface morphological and thermal analyses were performed before and after in vitro testing by means of scanning electron microscopy (SEM) and differential scanning calorimetry. Melting temperatures of silicones around 40°C were measured, before and after in vitro testing, respectively. Pellethane insulation layers had two endothermal melting regions at 100°C and 170°C before and a third melting region at 45°C after in vitro testing. The additional melting peak may indicate a change of thermal material properties due to degradation. SEM images showed degradation phenomena similar to in vivo studies, varying in severity and depending on the bending radius. Thus, the relevance of mechanical loading for in vitro replication of clinically relevant lead insulation degradation was demonstrated.

A time-resolved fibrosis model – in vitro assessment of antifibrotic implant coatings

Wound healing after implant surgery represents a spontaneous repair process that, when disturbed, can lead to a pathological situation known as fibrosis, characterized by excessive proliferation, increased extracellular matrix deposition, and scarring of the tissue. Tissue-specific cell culture models simulating physiological or pathophysiological cell responses are valuable research tools in the field of fibrosis, among others. In such in vitro systems, endpoint measurements are typically used to assess cell viability and/or proliferation. However, this approach is usually time consuming, costly and often leads to the destruction of the sample. Additionally, these conventional in vitro systems provide only a single snapshot of the respective sample at the end of the experiment. Therefore, we aimed to evolve the fibrotic disease in vitro model established by Stahnke et al. To this end, we chose a time-resolved, non-invasive approach based on cell impedance measurements and bright-field microscopy that allows continuous monitoring of the cells. Such measurements can be directly conducted using the xCELLigence RTCA eSight system. This system was used to characterize the cellular responses of the fibrosarcoma cell line HT-1080 and primary fibroblasts isolated from the Tenon’s capsule of human donors to TGF-β1, a key cytokine involved in the pathogenesis of fibrosis. The data shows that compared to Tenon’s fibroblasts the response of HT-1080 cells to TGF- β1 is less pronounced and only detectable within a narrow time frame. Thus, HT-1080 do not appear to be a suitable cell culture model for the assessment of antifibrotic implant coatings.

Thermal annealing of injection molded VHMW PLLA

In this study, DSC experiments were used to elaborate an annealing protocol for injection molded very high molecular weight (VHMW) PLLA with two molecular masses, 320,000 g/mol and 700,000 g/mol. The initial material obtained from the injection molding process was found to be highly amorphous and not in thermodynamic equilibrium state, as distinct cold crystallization and enthalpy relaxation were observed in DSC data. Thermal annealing to 85 °C for 60 - 90 min under controlled conditions using a DSC device showed to be sufficient to stabilize the polymer and increase the crystallinity to up to 50 %. Annealing did not result in any signs of thermal decomposition. The elaborated thermal treatment has been transferred to manual annealing of large specimen geometries for subsequent DMA analysis.

Influence of crosslinking on the drug release of PLLA/gelatin nonwovens

Electrospun fibers based on synthetic and natural polymers represent a promising approach in order to mimic the mechanical stability and the required cell-polymer interaction of the natural extracellular matrix (ECM), . In this biomedical context, the biodegradable medical grade poly-llactide (PLLA) and the natural gelatin are already well established. However, to obtain a stabilized structured PLLA/gelatin blend, crosslinking of gelatin is required. In this study, the influence of the post processed crosslinking via Glutaraldehyde (GTA) vapor and GTA solution on the morphological and physicochemical properties of the blend, as well as on the in vitrorelease of previously incorporated dexamethasone (DMS), was investigated. The addition of gelatin decreased the fiber diameter and increased the surface hydrophilicity, which is furthermore unaffected by the crosslinking process. The in vitrorelease of DMS was decisively changed by both, the addition of gelatin and the subsequent crosslinking processes. For all modified samples, a very rapid burst release of DMS was detected within the first 24 h, which is crucial for biomedical applications such as tumor therapy.

Water-supported femtosecond laser ablation of Nitinol for cardiovascular stents

Nitinol became one of the most prominent materials for biomedical devices. The unique properties such as the shape memory effect and the superelasticity enabled new applications, particularly in the field of stent technologies. Due to their thermosensitivity, manufacturing processes are required that control the heat accumulation in the material. Here we investigate the femtosecond laser ablation of Nitinol supported by a water flow inside the processed tube. We show that laser absorption in the water prevents annealing of the Nitinol, even for high pulse energies. Furthermore, we investigate the groove profiles by scanning electron microscopy and observe minor improvements in the processed structure when using water flow inside the tube. The results show that water-supported femtosecond laser ablation can be used to optimize the fabrication of medical devices such as cardiovascular stents and to reduce processing times.

XPS-Analysis of solvent residues in different polymeric biomaterials

For the use of polymers as biomaterials in the production of implants, several processing methods are needed. Besides injection molding or Fused Deposition Modeling as temperature based processes, also solvent based processes were performed such as solvent-casting and electrospinning. As fabrication of medical devices makes use of potentially hazardous or toxic solvents, they have to be extracted from the final medical device. For analyses of residual solvents different methods can be used e.g. gas chromatography (GC), coulometric elemental analysis or thermogravimetrical analyses (TGA). Here we present first results for the use of X-ray photoelectron spectroscopy (XPS) to yield elemental as well as spatial information on residual solvents in polymeric materials. Therefore we analysed PLLA as biodegradable electrospun polymer, TPC-ET as biostable polymer and a PLLA-iron composite as example of a polymer metal composite via XPS and etching processes. It was possible to determine residual halogen containing solvents in all tested polymers processed from polymeric solution. As discrimination between polymer and solvent was made possible by specific elements, XPS measurements may be a suitable tool to identify even small amounts of solvent. Thus XPS analyses will help to optimize polymer processing in order to remove residual solvents.

Design considerations and applications of a biomedical test bench development kit

Applications and requirements for biomedical test benches are often quite different, but there is always a need to monitor and usually to control processes. Commercially available development systems can be used to build simple laboratory setups up to industrial systems but are limited with respect to high costs and information for required validation. A test bench development kit is presented which ensures high compatibility for prospective developments, adaptations and embedding of sensors and actuators. The development kit is based on a printed circuit board built around the singleboard computer Raspberry PI. Supporting circuitry for power control, logics and special functions are implemented. Several types of peripheral devices can be connected via two serial bus standards (I2C, or RS-485). Current applications demonstrate the achieved level of automation and process control.

Fiber orientation on 3D structured collectors for electrospinning

Electrospinning, a standard technique for producing nonwoven fabrics, is widely used in the biomedical field. Due to local electric fields, fiber deposition is influenced by 3D surface structure of metallic collectors. For complex shaped structures, predicting the deposition and orientation of the fibers remains challenging. Investigations on well-defined structures permit a more detailed insight. In this study, metal blocks with round, slit and square holes of various sizes and depths were fabricated and covered with a thin layer of polymer fibers. The fiber arrangement of the layer was investigated by different microscopic methods. Analysis of the results showed less deposition on round holes and well-bridged aligned fibers on gaps which were less than four times wide as deep. Experimental results confirmed the theoretical predictions. Considering these findings, further work can be addressed to specific collector design to attain targeted fiber deposition.

Evaluation of a nonlinear viscoelastic-plastic constitutive model in numerical simulation of thermoplastic polymers for stent application

To simulate the specific material properties of thermoplastic polymers a suitable constitutive model is essential. The parallel rheological framework (PRF) model was calibrated and evaluated in this study as potential constitutive model for polymer stent application. Tensile as well as recovery tests with different loading rates were performed using PLLA specimens. In order to calibrate the constitutive model, the conducted material tests were simulated accordingly. The parameters of the model were iteratively varied to obtain good accordance of the simulation with the material tests. In contrast to elastic plastic material models, viscoelastic material behavior can be represented with the nonlinear viscoelastic-plastic PRF model. The generated and possibly further refined model can be used for the simulation of polymer stents.

Surface analysis of different O2-activated polyurethane-co-silicones using XPS

Polycarbonate-urethane-co-silicone (PCU-Sil) are gaining increasing interest in biomedical application, such as drug delivery systems, coatings and combination products, due to their adjustable mechanical properties. They can be easily processed using a wide range of methods. Biocompatibility can be improved by surface modifications, such as coupling drugs, proteins, antibodies or polymer layers, which extends the range of biomedical applications. To generate additional coupling, the first step would be the generation of functional groups on the polymer surface using surface activations, such as plasma activation. In this context, the assignment of the functional groups is important, which can be done by XPS measurements. Within this study the analysis of the generated functional groups after oxygen (O2) plasma activation of two PCU-Sils was performed. In addition, the stability of the generated surface modification was evaluated after 24 hours. It was surprising that the generated groups were differently stable and also different groups were generated or rearranged over time, which would not have been recognizable if only contact angle measurements were used.

Design study of dynamic mechanical test bench specimen grips

The characterization of mechanical properties of materials used in biomedical applications is essential for performance evaluation. In addition to quasi-static tests, dynamic tests extend the range of methods and allow predictions of failure, as well as information on durability. Appropriate specimen grips according to the test sample geometry are crucial for a reliable examination of mechanical testing and therefore valid experimental data. In particular, the investigation of polymers is challenging, as properties show major differences depending on temperature and applied loading rate. This could result in slipping or tearing of samples in the specimen grip area. Numerical simulations of reference grips, as well as alternative custom designs, were performed evaluating damage due to the clamping process and to provide appropriate specimen grips for future dynamic-mechanical investigations of materials with variable properties. Both the results of the numerical simulation and preliminary tests with 3D-printed prototypes show a distinct improvement in specimen clamping. Plastic deformation and local stress peaks were reduced while maintaining the same tightening torque.

Radial compliance of porcine coronary arteries ex vivo under pulsatile flow – perspectives for stent biomechanics

Besides visual assessment of the intra-vascular appearance, intravascular optical coherence tomography (IVOCT) enables precise diameter measurements within the coronary arteries. The current study presents an upgraded test setup allowing the investigation of the elastic properties of porcine coronary arteries ex vivounder pulsatile flow conditions. IV-OCT imaging was performed within the left circumflex artery of a porcine heart applying a normotensive and a hypertensive pressure regime at different pulse rates. Radial compliance was derived from the luminal diameter as well as intra-arterial pressure measurements. Test results show a significant reduction of radial compliance under pulsatile conditions, when compared to reference measurements under steady flow. The mean radial compliance decreased with increasing pulse rate, which can be attributed to the viscoelastic properties of the arterial wall.

Microstent for minimally invasive treatment of Fallopian tube occlusions – porcine implantation ex vivo

Involuntary female infertility represents a sensitive issue, which is frequently caused by an impaired patency of the Fallopian tube. Current treatment options, such as in vitro fertilisation (IVF) or tubal reconstruction, are related to high costs or surgical risks. Therefore, a need for an alternative highly safe and effective minimally invasive therapy option is assumed. The current work presents a proof-of-concept for a novel microstent in combination with a delivery system for treatment of proximal Fallopian tube occlusions. For this purpose, a microstent prototype was implanted into a porcine Fallopian tube ex vivo using the presented delivery system. The results of the procedure were analyzed using a micro-computed tomography (μ-CT). Based on the μ-CT imaging, critical parameters of the microstent, such as radial patency, were assessed. The microstent implantation leads to an increased opening area of the Fallopian tube. Additionally, the microstent does not impair the anatomical shape of the tube epithelium and adapts well to the anatomical path. In further studies, the functionality of the Fallopian tube will be examined after microstent implantation in vivo.

Characterization of Ball-milled Poly(Nisopropylacrylamide) Nanogels

Poly(N-isopropylacrylamide) (PNIPAM) hydrogels are one of the most commonly studied thermoresponsive biomaterials. In this work, we investigate ball milling as a method of producing PNIPAM nanogels and confirm that the temperature responsiveness is maintained in the nanogel form based on hydrodynamic diameter and zeta potential measurements.

Bacterial Adhesion and Biofilm Formation of Enterococcus faecalis on Zwitterionic Methylmethacrylat and Polysulfones

Biofilm-associated implant infections represent a major challenge for healthcare systems around the world due to high patient burden and enormous costs incurred. Enterococcus faecalis (E. faecalis) is the most prevalent enterococcal species identified in biofilm-associated infections. The steadily growing areas of application of implants demand a solution for the control of bacterial infections. Therefore, the development of modified anti-microbial implant materials and the testing of the behavior of different relevant bacterial strains towards them display an indispensable task. Recently, we demonstrated an anti-microbial effect of zwitterionic modified silicone rubber (LSR) against Staphylococcus aureus. The aim of this study was to evaluate bacterial colonization and biofilm formation of another clinically relevant strain, E. faecalis, on this material in comparison to two of the most commonly used thermoplastic polyurethanes (TPUs) and other modified LSR surfaces. By generating growth curves, crystal violet, and fluorescence staining, as well as analyzing the expression of biofilm-associated genes, we demonstrated no anti-microbial activity of the investigated materials against E. faecalis. These results point to the fact that anti-microbial effects of novel implant materials do not always apply across the board to all bacterial strains.

A PLLA Coating Does Not Affect the Insertion Pressure or Frictional Behavior of a CI Electrode Array at Higher Insertion Speeds

To prevent endocochlear insertion trauma, the development of drug delivery coatings in the field of CI electrodes has become an increasing focus of research. However, so far, the effect of a polymer coating of PLLA on the mechanical properties, such as the insertion pressure and friction of an electrode array, has not been investigated. In this study, the insertion pressure of a PLLA-coated, 31.5-mm long standard electrode array was examined during placement in a linear cochlear model. Additionally, the friction coefficients between a PLLA-coated electrode array and a tissue simulating the endocochlear lining were acquired. All data were obtained at different insertion speeds (0.1, 0.5, 1.0, 1.5, and 2.0 mm/s) and compared with those of an uncoated electrode array. It was shown that both the maximum insertion pressure generated in the linear model and the friction coefficient of the PLLA-coated electrode did not depend on the insertion speed. At higher insertion speeds above 1.0 mm/s, the insertion pressure (1.268 ± 0.032 mmHg) and the friction coefficient (0.40 ± 0.15) of the coated electrode array were similar to those of an uncoated array (1.252 ± 0.034 mmHg and 0.36 ± 0.15). The present study reveals that a PLLA coating on cochlear electrode arrays has a negligible effect on the electrode array insertion pressure and the friction when higher insertion speeds are used compared with an uncoated electrode array. Therefore, PLLA is a suitable material to be used as a coating for CI electrode arrays and can be considered for a potential drug delivery system.

Evaluation of a Murine Model for Testing Antimicrobial Implant Materials in the Blood Circulation System

Medical device-related infections are becoming a steadily increasing challenge for the health care system regarding the difficulties in the clinical treatment. In particular, cardiovascular implant infections, catheter-related infections, as well as infective endocarditis are associated with high morbidity and mortality risks for the patients. Antimicrobial materials may help to prevent medical device-associated infections and supplement the currently available therapies. In this study, we present an easy-to-handle and simplified in vivo model to test antimicrobial materials in the bloodstream of mice. The model system is composed of the implantation of a bacteria-laden micro-stent scaffold into the murine tail vein. Our model enables the simulation of catheter-related infections as well as the development of infective endocarditis specific pathologies in combination with material testing. Furthermore, this in vivo model can cover two phases of the biofilm formation, including both the local tissue response to the bacterial biofilm and the systemic inflammatory response against circulating bacteria in the bloodstream that detached from a mature biofilm.

Side-branch expansion capacity of contemporary DES platforms

Background

Percutaneous coronary interventions (PCI) of bifurcation stenoses are both complex and challenging. Stenting strategies share that the stents’ side cells must be carefully explored and appropriately prepared using balloons or stents. So far, stent manufacturers have not provided any information regarding side-branch expansion capacity of their stent platforms.

Aims

Given that drug-eluting stent (DES) information regarding their mechanical capacity of side-branch expansion is not available, we aimed to evaluate contemporary DES (Orsiro, BIOTRONIK AG; Xience Sierra, Abbott Vascular; Resolute Integrity, Medtronic; Promus Premier Select, Boston Scientific; Supraflex Cruz, Sahajan and Medical Technologies) by their side-branch expansion behavior using in vitro bench testing.

Methods

In this in vitro study, we analyzed five commercially available DES (diameter 3.0 mm), measuring their side-branch expansion following inflation of different high-pressure non-compliant (NC) balloons (balloon diameter: 2.00–4.00 mm), thereby revealing the morphological characteristics of their side-branch expansion capacities.

Results

We demonstrated that all tested contemporary DES platforms could withstand large single-cell deformations, up to 4.0 mm. As seen in our side-branch experiments, DES designs consisting of only two connectors between strut rings did not only result in huge cell areas, but also in larger cell diameters following side-branch expansion compared with DES designs using three or more connectors. Furthermore, the stent cell diameter attained was below the balloon diameter at normal pressure.

Conclusions

We recommend that the expansion capacity of side-branches should be considered in stent selection for bifurcation interventions.

In Vitro Study of the Interaction of Innate Immune Cells with Liquid Silicone Rubber Coated with Zwitterionic Methyl Methacrylate and Thermoplastic Polyurethanes

The biocompatibility of medical devices, such as implants and prostheses, is strongly determined by the host's immune response to the implanted material. Monocytes and macrophages are main actors of the so-called foreign body reaction. The innate immune system macrophages (M) can be broadly classified into the pro-inflammatory M1-type and the anti-inflammatory, pro-healing M2-type. While a transient inflammatory initial state can be helpful during an infection, persistent inflammation interferes with proper healing and subsequent regeneration. The functional orientation of the immune response, mirrored by monocyte polarization, during interaction with different biomaterials has not yet been sufficiently explored. In implant manufacturing, thermoplastic polyurethane (TPU) represents the state-of-the-art material. The constantly growing areas of application and the associated necessary adaptations make the optimization of these materials indispensable. In the present study, modified liquid silicone rubber (LSR) were compared with two of the most commonly used TPUs, in terms of monocyte adhesion and M1/M2 polarization in vitro. Human monocytes isolated from venous blood were evaluated for their ability to adhere to various biomaterials, their gene expression profile, and their cytokine release. Based on the results, the different polymers exhibit different potential to bias monocytes with respect to early pro-inflammatory cytokine production and gene transcription. Furthermore, none of our test materials showed a clear trend towards M1 or M2 polarization. However, we were able to evaluate the inflammatory potential of the materials, with the classic TPUs appearing to be the most unreactive compared to the silicone-based materials.

Automation of online particle measurement during the simulated use of catheters and stent systems

The assessment of the coating integrity of cardiovascular implants such as catheters and stent systems is of crucial importance for device approval. Released particles may represent a potential health risk for the patients. Thus, an analysis of the particles released at simulated in-vivo conditions depending on their size and number is required by international standards (ISO, ASTM) as well as national authorities. In this study, an automated test bench for online particle measurement is presented. For software controlled automation, sensor data transmission and solenoid valves were implemented. A user interface was created for setting test parameters and data recording. The setup was validated by investigating standard particles as well as those released during the simulated application of non-industrial coated balloons. The measurement data were compared with results generated using the previous manual test routine. The results show an improvement in the reproducibility of the measurements, which can be attributed to the simplified handling for the user.

Non-destructive analysis of drug distribution in nonwovens as drug-delivery systems for biomedical applications

Analysis of the active ingredient distribution of medical devices is typically performed using Raman spectroscopy, a method that is fast and inexpensive [1]. In addition, it offers the advantage of non-destructive analysis without the need for special sample preparation. Assuming that all components are Raman-active and present in sufficient quantities, their distribution can be well represented. The drug distribution in dexamethasone-loaded polymer nonwovens was investigated in order to draw conclusions on the quality of the fleece batches and to make predictions for the release behavior. In the present study, dexamethasone (DMS), a glucocorticoid was used as the active ingredient. Qualitative and quantitative studies of the content of DMS in polymer films by means of Raman spectroscopy have already been carried out in the working group [2]. A representative square section was examined to describe the distribution of active ingredients. The required number of measurement points (spectra) was determined earlier [2].

Influence of sterilization on the drug release behaviour of drug coated silicone

Sterilization processes ensure sterility of drug delivery systems, but may negatively affect the properties of biomaterials and incorporated drugs by changing their physical, chemical, mechanical properties and drug release behaviour. Therefore, it is important to investigate their influence. In this study, the influence of ethylene oxide (EtO) sterilization on the drug loading and release behaviour of incorporated Diclofenac (DCF) in a Poly-L-lactide (PLLA) coating and Dexamethasone (DMS) in the silicone carrier is presented. Silicone samples containing DMS were coated with PLLA containing DCF varying in layer thickness (5, 10, and 20 μm). Half of the samples underwent EtO sterilization, the other half was not sterilized. All un-/sterilized sample surfaces were in view of the morphology and hydrophilicity examined. Furthermore, in vitro release studies of DMS and DCF were conducted. The sterilized sample surfaces showed no morphological and hydrophilicity changes. The DCF and DMS loadings were similar for the sterile and untreated samples. This also applied to the in vitro DMS release profiles apart from the end of the studies where slight differences were evident. The results indicate that both drugs loaded in the polymer coating and the silicone were not impaired by the sterilization process. Thus, EtO sterilization appears suitable for DMS containing silicone and DCF incorporated PLLA coatings as a dual drug delivery system.

Development and validation of a test facility for pivotal characterization of glaucoma drainage devices

Implant devices for micro invasive glaucoma surgery (MIGS) are gaining increasing acceptance in clinical ophthalmic use. The implant requirements are defined in international standards, such as ANSI Z80.27-2014 and the 2015 Guidance for Industry and Food and Drug Administration Staff “Premarket Studies of Implantable Minimally Invasive Glaucoma Surgical (MIGS) Devices”. The exact fluid-mechanical characterization represents a crucial part of the development and approval of innovative implant devices for MIGS. The current work describes the development and preliminary validation of a versatile test facility for pivotal characterization of glaucoma drainage devices. The test setup enables a pressurization of test specimens by means of two water columns. For measurement of pressure and volume flow, a pressure transducer and a total of three liquid flow meters were implemented into the test setup. Validation was conducted by experimental pressureflow characterization of standardized tubes and a comparison to theoretical results according to Hagen Poiseuille's law for stationary laminar flow of a Newtonian fluid in a tube with a circular cross section. Ultrapure water at (35 ± 2) °C was used for the analyses. The developed test setup potentially enables pressure-flow characterization of test specimens in a wide flow range of 0 μl min-1 ≤ Q ≤ 5.000 μl min-1. The preliminary test facility validation showed a good agreement of measured and theoretical volume flow characteristics as a function of the pressure difference, in the currently investigated flow range of Q < 80 μl min-1. The developed test facility is suitable for pivotal in vitro characterization of glaucoma drainage devices. Future investigations will focus on the final validation of the whole flow range and on the use of the test facility for fluid-mechanical characterization of self-developed prototypes of glaucoma microstents as well as commercially available glaucoma drainage devices.

Dry vs. wet testing: quasi-static tensile experiment setup for polymer based biomaterials

Polymer materials can be manufactured with high reproducibility and do offer the potential for chemical modification. This enables matrix property modification and fine-tuning of several material characteristics, such as tissue-implant interaction, inflammatory potential or susceptibility to biofilm formation. Whereas manufacturing protocols are crucial for the resulting material properties, also the evaluation in terms of performance and safety has to be considered. Regarding this, both, temperature and composition of test medium may affect the physicochemical properties of implant materials. The present study addresses the influence of test medium compared to dry test conditions, each at two different temperatures, on the mechanical properties of elastomeric film and nonwoven materials.

Fiber composite materials via coaxial, dual or blend electrospinning

Electrospinning (ES) is a suitable and cost effective method to mimic the chemical composition, morphology, and functional surface of natural tissues, for example of the nervous, dermal, vascular, and musculoskeletal systems. This technique is a versatile tool to obtain tailored fibrous scaffolds from various polymer materials. By varying the diameter, porosity, orientation, layering, surface structuring, mechanical properties and biodegradability of the fibers the properties can be adapted for specific applications ranging from implantable medical devices to wound repair and protective clothing. Especially the combination of different polymer types offers a high potential. In this study electrospun two-component nonwoven structures of thermoplastic copolyester elastomer (TPC-ET) and bioresorbable polylactide (PLLA) were fabricated, using different ES setups. A comparative evaluation in terms of porosity, thermal and mechanical properties as well as required fabrication effort, was performed. Nonwovens made from polymer blends and coaxial spun core-sheath fibers showed similar tensile strength, which was higher than dual electrospun fabrics. Porosity was found to be in the range of 80 - 90%. By modifying the polymer solution and process parameters multicomponent nonwoven structures with tailored properties and drug release profiles can be manufactured.

Preadaptation of cell numbers for wound healing assays

In vitro wound healing assays are a suitable application to verify the efficiency of pharmaceuticals or growth factors that will be incorporated in or immobilized to e.g. electrospun biomaterials for wound dressings or other biological devices in advance. Thereby, various factors like culture conditions or cell density influence the specific cell proliferation. Hence, to establish a wound healing assay for various cell types, a stepwise adaptation of cell numbers was done for better estimation and comparison of cell density for the validation of the influence of drugs on the wound healing process. Cell proliferation of different tissue relevant cell types was evaluated by impedance measurements and live cell imaging. Cell numbers could be successfully adapted for assay specific cell densities. In general, a universal comparison of biological or chemical materials and agents in vitro may require the creation of appropriate ISO or OECD standards for a consistent and cell specific adaptation or demand of initial cell density.

Comparison of Characteristics of Poly(Nisopropylacrylamide) in Bulk Hydrogel and Ball-milled Microgel Forms

Poly(N-isopropylacrylamide) hydrogels are a popular temperature sensitive biomaterial. Bulk hydrogels can be quickly and easily processed into microgels using a ball mill. However, there is no information on whether the mechanical milling process affects critical PNIPAM characteristics. In this work, we compare swelling and thermo-responsive properties for a series of PNIPAM gels in bulk and microgel forms.

Impact of statins on vascular scaffolds response in porcine carotid arteries

Surgical treatments of arterial occlusive disease with fully absorbable polymeric scaffolds, as a potential alternative to permanent metallic stents, are increasingly penetrating the clinical field. An addition part of the management of patients suffering from vascular diseases is the administration of statins. In this study, absorbable x-ray marked PLLA-based polymer scaffolds and permanent bare-metal stents (BMS) were implanted interventionally into both common carotid arteries (CCA) of 6 healthy female pigs via the left common iliac artery (8F-sheath). The pigs were administered dual antiplatelet drugs oral starting 3 days before the procedure until the end of the study. In Addition, the pigs received atorvastatin orally, beginning 5 days prior to surgery and lasting until the study ended. Stented CCA segments were explanted after 4 weeks, and processed for quantitative histomorphometry, and estimation of vascular inflammation and injury scores. Polymer scaffolds showed a decreased residual lumen area and higher stenosis after 4 weeks (6.41 ± 0.83 mm² and 40.52 ± 5.01%) as compared to the bare-metal reference stent (15.17 ± 0.896 mm² and 7.80 ± 0.88%). After 4 weeks, inflammation score were higher in the polymer group (1.30 ± 0.37) compared to the BMS group (0.42 ± 0.18). In contrast, the BMS showed a slightly elevated vascular injury score (0.85 ± 0.12), as compared to the polymer (0.60 ± 0.23) group. In this preclinical model, the new absorbable polymeric scaffolds showed similar technical feasibility and safety for vascular application as the permanent metal stents. Although no positive trends were observed with oral treatment with atorvastatin, further optimization with a dual-loaded coating is still reasonable. In addition, reduced strut thickness of the polymer scaffolds would have potential to positively impact tissue ingrowth between struts and should be considered in future work on stent design.

Comparison of temperature mapping methods for experimental validation of numerical heat transfer analysis of biomaterials and medical devices

Titanium represents an important biomaterial for implantable medical devices. During medical device manufacturing by means of welding, implant structures are partially exposed to high temperatures. Additionally, active implants such as pacemakers can heat up during operation. Therefore, numerical studies of heat propagation within titanium structures represent an essential tool to assess functionality and safety of medical devices. The current study focusses on the development of a method for experimental validation of numerical heat transfer analysis of biomaterials such as titanium. Numerical heat transfer analysis was performed using the software Abaqus. A finite-element model was established including material properties such as density, thermal conductivity und specific heat capacity. Temperature distribution among a locally applied thermal load was calculated. Furthermore, effects such as convection were considered. For validation, an experimental setup was implemented according to the numerical calculation using a local heating tool. Heat propagation in the sample was determined, respectively. Radiation-based heat determination was performed using an infrared thermographic camera aligned parallel to the sample surface. Contact-based heat determination was performed using thermocouples fixed to the surface at defined distances from the point of local heat input. For evaluation of numerical and experimental results, temperature- time curves were compared for five distinct measuring points, respectively. While infrared thermography offers the advantage of non-contact measurements, difficulties may arise from the definition of correct emissivity and challenging sample surface characteristics, such as metallic reflectance and surface texture. The thermocouple-based temperature measurement shows a high sensitivity to local temperature changes, but it is not always suitable due to the influence on the sample by thermocouple fixation. Infrared thermography and thermocouple based temperature measurements represent suitable procedures for experimental validation of numerical heat transfer analysis of titanium. An individual decision for the most suitable method must be made considering the specific sample and its further application.

Cardiovascular catheter stiffness – a static measurement approach

Catheters are widely used for therapeutic and diagnostic purposes in various medical applications. Along with frictional properties as well as the catheter profile the catheter stiffness mainly affects the deliverability and thus, the handling properties of the catheter. Within this study the bending stiffness of proximal and distal catheter samples was investigated with a custom made test setup. In particular, the influence of the catheter clamping length on the test results is discussed. Bending stiffness was calculated directly from the measured force, deflection and clamping length considering the test setup compliance. Measurements were performed three times at five positions in circumferential direction. Measured bending stiffness ranged from 629 ± 31 Nmm² to 733 ± 58 Nmm² for the proximal samples and from 30 ± 5 Nmm² to 98 ± 30 Nmm² for the distal samples, respectively. Bending stiffness varied depending on the free catheter length and the reaction force measured. The maximum reaction force decreased with increasing free catheter length leading to a higher measurement uncertainty. However, when considering the same free catheter length quantitative results were similar within the group of proximal and distal samples, respectively.

TAVI-Mimic for testing of heart valve leaflet materials in physiological loading situations

The loading situation of the aortic valve is complex, complicating the identification of innovative approaches for heart valve leaflet materials, e.g. for transcatheter aortic valve implantation (TAVI). Materials engineering experiments allow for screening of materials but especially for durability testing, the consideration of physiological loads is vital/critical for the suitability-assessment of innovative leaflet materials. For this reason, a framework structure for the testing of leaflet materials in physiological loading (TAVI-Mimic) was developed. The exemplary use case for the TAVI-Mimic was a test for calcification propensity of pericardium during durability testing. The TAVI-Mimic was designed as a fourparted frame, based on previous work of our group. The leaflet material can be attached between inner and outer shells without sewing. In a second step, the TAVI-Mimic was optimized regarding radial load-deformation in comparison to a commercial TAVI by means of finite element analysis (FEA) and hydrodynamic characterization in a pulse duplicator system. Mechanical properties dependent on water uptake of different materials for 3D-printing of the TAVI-Mimic were investigated. After optimization, TAVI-Mimics were equipped with glutaraldehyde-fixated pericardial tissue and prototypes were calcified by using a heart valve durability tester and a metastable calcification-liquid, developed in earlier studies. The development of the TAVI-Mimic using FEA and experiments was successful, leading to a radial load dependent deformation of 0.6 mm which correlates with commercial TAVI. Two methacrylic photopolymers were identified for 3D-printing of the TAVI-Mimic and prototypes attached with pericardial tissue were manufactured. Pericardium TAVI-Mimics were calcified in vitro for one week and an average calciumphosphate precipitate of 0.34- 0.54 mg/cm² was measured. The optimization of the TAVR-Mimic led to an improved load-dependent behaviour compared to a commercial prosthesis while testing. The calcification method, combining the TAVI-Mimic, the metastable calcification solution and the durability tester enabled a successfully calcification of pericardial tissue, approaching the in vivo situation.

A two-stage finite element based method for the study of stiffness and failure load of osteoporotic spines

A two-step method for investigating the stiffnesses and failure loads of vertebral bodies is presented. It is based on the representation of the spine in a global finite element model of structural elements. A detailed model of two interconnected vertebrae and an intervertebral disc was implemented. Calculations on this model are shown which illustrate the dependencies of structural stiffnesses on vertebral body properties. These structural stiffnesses can then be used to represent the spine in the global model.

Polymer selection for Eustachian tube stent application based on mechanical, thermal and degradation behavior

The novel concept of stenting the Eustachian tube was established to provide an effective and safe therapy of Eustachian tube dysfunction. Biodegradable polymer stents are being developed to restore impaired tube function. As the supporting effect may be required for different time periods, PLA-co-PEG copolymers, PLLGA, PDLLA and PDS, having shorter degradation times compared to PLLA, were evaluated as potential stent materials. Since tensile tests and thermal analyses of solvent cast films from PLA-co-PEG copolymers showed comparable properties to PLLA, stent samples were manufactured from these materials. Mechanical stent testing revealed an increase of elastic recoil and slight decrease of collapse pressure compared to PLLA. In a short term accelerated degradation study a considerable percentage molar mass reduction and an increasing degree of crystallinity depending on PEG content was found. Based on the results obtained, the tested polymers offer a promising, faster degradable alternative to the established stent material PLLA.

Validation of Finite Element Analysis of a selfexpanding polymeric microstent for treatment of Fallopian tube occlusions

Proximal occlusion of the Fallopian tube is one of the most common causes of female infertility. Due to the occlusion, the passage of the fallopian tubes is no longer given. Basically, there are two options for patients affected by this condition: cost-intensive in vitro fertilization (IVF) or surgery. The pregnancy rates of approximately 50% achieved with current treatment options are not satisfying. In this work, we present a Finite Element Analysis (FEA) model of a previously reported optimized microstent design for minimally invasive therapy of proximal tubal occlusion. Based on experimental investigations, the material model was set up and the simulation was validated. Comparison of the mechanical performance as an application related critical load case was in a good agreement. In this work, the proof of concept for the FEA model and the material model were carried out. In the future, the simulation will be used for further load cases such as the investigation of the bending stiffness and radial force and for the design optimization.

Fiber statistics of nonwoven materials by SEM images - influence of number of images

Electrospun nonwovens are widely applied in biomedicine and various other fields. For control of the manufacturing process and quality assurance Scanning electron microscopy (SEM) imaging is one standard practice. In this study, statistical datasets of 60 SEM images of three nonwoven samples were evaluated using Gaussian fit to obtain numerical results of their fiber diameter distributions. The question of how much effort is required for acceptable imaging and processing is being discussed. As determined here, for reliable statistics, a minimum surface area of the nonwoven has to be evaluated. The fiber diameter should be in a range of approximately 2 - 3% of the edge length of the square equivalent of the evaluated image area, using sufficiently magnified SEM images, in which the fiber diameter is imaged over at least 30 pixels.

Establishment of suitable parameters for laser machining based production of polymeric implants

Laser material processing enables precise machining of a wide variety of materials. In order to prevent an excessive heat input, which leads to irreversible material damage, the process parameters have to be adapted to the processed material. To keep the heat load as low as possible, the potential of femtosecond laser technology is exploited. The processing of semi-finished products using femtosecond laser technology is highly depending on the processed material. In this regard, we established a workflow and basic parameters for the processing of polymeric material. The performed parameter study varying cutting speed, cutting gas pressure and pulse energy to optimize the manufacturing process. Scanning electron microscopy (SEM) was utilized to analyze the cutting results, such as cut edge quality or possible melted areas. The established parameter set is also suitable for processing of very filigree material structures as used in innovative medical devices. The SEM analysis of the established parameter set showed that a homogeneous, nonwavy cut edge was created along the kerf.

Universal single-board computer based control unit for biomedical test benches

Continuous adaptation of international standards for medical devices requires recurrent modification of test benches. A universal control unit using an open software environment is presented to simplify the maintenance of various test benches. Our developed control unit is equipped with a Raspberry Pi 4, with standard communication interfaces and application-specific electronic assemblies. The software is based on Node-RED, a browser-based editor. A measuring setup was adapted for a flow perfusion system. Our control unit simplifies the handling of the flow perfusion system by controlling a hydraulic pump and all required valves. A software programmed PID algorithm adapts the speed of the pump to adjust the pressure automatically. Actuators like proportional pinch valves are handled to control volumetric flow and pressure within the circulation. Consequently, the user directly observes changes inside the system. The measured data are stored and are available for documentation.