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Very fine and sinterable ceramic powders (100-600 nm) in the system Al2O3-TiO2-SiO2 were obtained by the method of cohydrolisis from organo-metallic precursors. Isostatically pressed powder compacts could be densified to a relative high density (~ 92 % th. density) at relative low temperatures (1320-1380ºC). The technical coefficient of thermal expansion was measured by dilatometry. The value obtained (8.8 10-6 1/ºC) corresponds closely to that of Ti, opening the possibility to use Al2O3-TiO2-SiO2 ceramics to fabricate metal/ceramic composite implants. The measured mechanical properties of dense sintered Al2O3-TiO2-SiO2 material: Young´s modulus, flexure strength and compression strength, are higher than those of pure TiO2. Highly porous Al2O3-TiO2-SiO2 ceramics (P~ 65%) were obtained by the method of evaporation of hydrogen peroxide. These materials exhibited interconnected porosity and their properties, particularly the Young´s modulus, resulted very similar to those of bone, which is an important pre-requisite for the design of quirurgical implants.Se han obtenido polvos cerámicos muy finos (100- 600 nm) y de alta sinterabilidad, en el sistema Al2O3-TiO2-SiO2, por el método de co-hidrólisis controlada a partir de precursores organo-metálicos. Los compactos fabricados a partir del polvo de cohidrólisis calcinado fueron sinterizados en el rango de temperaturas 1320-1380 ºC, obteniéndose densidades elevadas (~ 92% D.T.). El coeficiente de expansión térmica técnico del material cerámico sinterizado fue medido por dilatometría. El valor obtenido, 8.8 10-6 ºC-1, es muy similar al de titanio metálico y por lo tanto el material cerámico Al2O3-TiO2-SiO2 puede ser candidato para la fabricación de implantes compuestos cerámico/metal. Las propiedades mecánicas: módulo de elasticidad, resistencia a la flexión y resistencia a la compresión, del material denso sinterizado, fueron determinadas, resultando muy superiores a las de TiO2 puro. Se obtuvieron materiales cerámicos de alta porosidad (P ~ 65 %) por el método de evaporación de peróxido de hidrógeno. Estos materiales exhibieron porosidad interconectada y sus propiedades mecánicas, en particular el módulo de Young, resultaron similares a las de material óseo, como se requiere para el diseño de implantes quirúrgicos.

Objectives: Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany., Methods: Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020., Results: Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation., Conclusions: Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients., Practice Implications: Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Incorporation of biodegradable poly(lactic-co-glycolic acid; PLGA) fibers into calcium phosphate cements (CPCs) has proven beneficial for their mechanical properties and the targeted delivery of bone morphogenetic proteins (BMPs). However, the deficiency of functional groups on the PLGA surface results in poor fiber-matrix interfacial strength (ISS), limiting the mechanical improvement, and insufficient surface charge to immobilize therapeutic amounts of BMPs. The present study therefore focused on the: i) functionalization of PLGA fibers using polyelectrolyte multilayers (PEMs) of biopolymers; ii) analysis of their impact on the mechanical properties of the CPC in multifilament fiber pull-out tests; and iii) testing of their applicability as carriers for BMPs using chemical-free adsorption of biotinylated recombinant human growth factor (rhGDF-5) and colorimetric assays. The PEMs were created from chitosan (Chi), hyaluronic acid (HA), and gelatin (Gel) via layer-by-layer (LbL) deposition. Four PEM nanocoatings consisting of alternating Chi/Gel and Chi/HA bilayers with a terminating layer of Chi, Gel or HA were tested. Nanocoating of the PLGA fibers with PEMs significantly enhanced the ISS with the CPC matrix to max. 3.55 ± 1.05 MPa (2.2-fold). The increase in ISS, ascribed to enhanced electrostatic interactions between PLGA and calcium phosphate, was reflected in significant improvement of the composites' flexural strength compared to CPC containing untreated fibers. However, only minor effects on the composites' work of fracture were observed. The adsorption of rhGDF-5 on the PLGA surface was supported by PEMs terminating with either positive or negative charges, without significant differences among the nanocoatings. This proof-of-principle rhGDF-5 immobilization study, together with the augmented ISS of the composites, demonstrates that surface modification of PLGA fibers with biopolymers is a promising approach for targeted delivery of BMPs and improved mechanical properties of the fiber-reinforced CPC., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

It has been recently recognized that controlled surface structuring on the nanometer scale is a successful strategy to endow different materials with antimicrobial properties. Despite many studies on bacterial interactions with nanostructured surfaces, a quantitative link between surface topography and bacterial adhesion is still missing. To quantitatively link cell adhesion data with topographical surface parameters, we performed single-cell spectroscopy on chemically identical surfaces with controlled nano-contact point density achieved by immobilization of gold nanoparticles (AuNP) on gold thin films. Such materials surfaces have previously shown antimicrobial (anti-adhesive) efficacy towards Gram-negative Escherichia coli cells. In the current study, the influence of nano-structured surfaces on the surface coverage and adhesion forces of clinically relevant Candida albicans (C. albicans), the fungus primarily associated with implant infections, was investigated to validate their antimicrobial potency against different microbial cells. The adhesion forces of C. albicans cells to nanostructured surfaces showed a decreasing trend with decreasing contact-point density and correlated well with the results of the respective C. albicans cell counts. The surfaces with the lowest contact-point density, 25 AuNP/μm², resulted in an average adhesion force of 5 nN, which was up to 5 times lower compared to control and 61 AuNP/μm² surfaces. Further, detailed analyses of force-distance curves revealed that the work of adhesion, and thus the energy required to remove the C. albicans cell from the surface is up to 10 times lower on 25 AuNP/μm² surfaces compared to unstructured surfaces. These findings show that a controlled tuning of nanostructured surfaces in terms of accessible nano-contact points is crucial to generate surface structures with enhanced antimicrobial properties. The gained knowledge can be further exploited for the design of biomaterials surfaces to prevent adhesion of some most commonly encountered pathogens., Competing Interests: Declaration of Competing Interest The authors declare no competing interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Surface structures in the nanometer range emerge as the next evolutionary breakthrough in the design of biomaterials with antimicrobial properties. However, in order to advance the application of surface nanostructuring strategies in medical implants, the very nature of the microbial repealing mechanism has yet to be understood. Herein, we demonstrate that the random immobilization of gold nanoparticles (AuNPs) on a material's surface generates the possibility to explore microbial adhesion in dependence of contact point densities at the biointerface between the microbe, i.e., Escherichia coli and the material's surface. By optimizing the contact point density defined by individual AuNPs, yet keeping the surface chemistry unchanged as evidenced by X-ray photoelectron spectroscopy, we show that the initial microbial adhesion can be successfully reduced up to 50%, compared to control (unstructured) surfaces. Furthermore, we observed a decrease in the size of microbial cells adhered to nanostructured surfaces. The results show that the spatial distance between the contact points plays a crucial role in regulating microbial adhesion, thus advancing our understanding of the microbial adhesion mechanism on nanostructured surfaces. We suggest that the introduced strategy for nanostructuring materials surfaces opens a research direction for highly microbial-resistant biomaterials., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Occlusion by thrombosis due to the absence of the endothelial cell layer is one of the most frequent causes of failure of artificial vascular grafts. Bioinspired surface structures may have a potential to reduce the adhesion of platelets contributing to hemostasis. The aim of this study was to investigate the hemodynamic aspects of platelet adhesion, the main cause of thrombosis, on bioinspired microstructured surfaces mimicking the endothelial cell morphology. We tested the hypothesis that platelet adhesion is statistically significantly reduced on bioinspired microstructured surfaces compared to unstructured surfaces. Platelet adhesion as a function of the microstructure dimensions was investigated under flow conditions on polydimethylsiloxane (PDMS) surfaces by a combined experimental and theoretical approach. Platelet adhesion was statistically significantly reduced (by up to 78%; p≤0.05) on the microstructured PDMS surfaces compared to that on the unstructured control surface. Finite element method (FEM) simulations of blood flow dynamic revealed a micro shear gradient on the microstructure surfaces which plays a pivotal role in reducing platelet adhesion. On the surfaces with the highest differences of the shear stress between the top of the microstructures and the ground areas, platelet adhesion was reduced most. In addition, the microstructures help to reduce the interaction strength between fluid and surfaces, resulting in a larger water contact angle but no higher resistance to flow compared to the unstructured surface. These findings provide new insight into the fundamental mechanisms of reducing platelet adhesion on microstructured bioinspired surfaces and may lay the basis for the development of innovative next generation artificial vascular grafts with reduced risk of thrombosis., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Microbial adhesion to natural and synthetic materials surfaces is a key issue e.g. in food industry, sewage treatment and most importantly in the biomedical field. The current development and progress in nanoscale structuring of materials surfaces to control microbial adhesion requires an advanced understanding of the microbe-material-interaction. This study aimed to investigate the nanostructure of the microbe-material-interface and link it to microbial adhesion kinetics as function of titanium surface nanoroughness to gain new insight into controlling microbial adhesion via materials' surface nanoroughness. Adhesion of Escherichia coli and Staphylococcus aureus was statistically significantly reduced (p≤0.05) by 55.6 % and 40.5 %, respectively, on physical vapor deposited titanium thin films with a nanoroughness of 6nm and the lowest surface peak density compared to 2nm with the highest surface peak density. Cross-sectioning of the microbial cells with a focused ion beam (FIB) and SEM imaging provided for the first time direct insight into the titanium-microbe-interface. High resolution SEM micrographs gave evidence that the surface peaks are the loci of initial contact between the microbial cells and the material's surface. In a qualitative model we propose that the initial microbial adhesion on nanorough surfaces is controlled by the titanium surface peak density via nano adhesion points. This new understanding will help towards the design of materials surfaces for controlling microbial adhesion., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Biodegradable calcium phosphate cements (CPCs) are promising materials for minimally invasive treatment of bone defects. However, CPCs have low mechanical strength and fracture toughness. One approach to overcome these limitations is the modification of the CPC with reinforcing fibers. The matrix-fiber interfacial shear strength (ISS) is pivotal for the biomechanical properties of fiber-reinforced CPCs. The aim of the current study was to control the ISS between a brushite-forming CPC and degradable PLGA fibers by oxygen plasma treatment and to analyze the impact of the ISS alterations on its bulk mechanical properties. The ISS between CPC matrix and PLGA fibers, tested in a single-fiber pull-out test, increased up to 2.3-fold to max. 3.22±0.92MPa after fiber oxygen plasma treatment (100-300W, 1-10min), likely due to altered surface chemistry and morphology of the fibers. This ISS increase led to more efficient crack bridging and a subsequent increase of the post-peak residual strength at biomechanically relevant, moderate strains (up to 1%). At the same time, the work of fracture significantly decreased, possibly due to an increased proportion of fractured fibers unable to further absorb energy by frictional sliding. Flexural strength and flexural modulus were not affected by the oxygen plasma treatment. This study shows for the first time that the matrix-fiber ISS and some of the resulting mechanical properties of fiber-reinforced CPCs can be improved by chemical modifications such as oxygen plasma treatment, generating the possibility of avoiding catastrophic failures at the implant site and thus enhancing the applicability of biodegradable CPCs for the treatment of (load-bearing) bone defects., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Injectable, brushite-forming calcium phosphate cements (CPCs) have great potential as bone replacement materials due to enhanced degradability and long-term inclusion in bone remodeling. However, the use of such brushite-forming CPCs in load-bearing areas is limited by their low mechanical strength. One approach to overcome this limitation is the use of reinforcing fibers. Thus, an injectable, biodegradable, brushite-forming CPC based on beta-tricalcium phosphate/phosphoric acid with fiber reinforcement was developed for minimally invasive surgery. The fibers (diameter 25 µm; length 0.25, 1 or 2mm) were extruded from poly(l-lactide-co-glycolide) acid (PLGA) and added to the CPC (2.5, 5 or 7.5% (w/w)). Independent of the fiber content, injectability of the CPC was retained up to a fiber length of 1mm. The addition of all PLGA fiber types increased diametral tensile strength, biaxial flexural strength, and flexural strength by up to 25% (p ≤ 0.05 for the diametral tensile strength for the CPC with 5% (w/w) 1mm fibers and the biaxial flexural strength of the CPC with 5% (w/w) 0.25 mm fibers). In contrast, the work of fracture strongly and significantly increased (p<0.01) by up to 12.5-fold. At constant fiber content, the mechanical properties of the fiber-reinforced CPC were mostly augmented with increasing fiber length. Also, the addition of PLGA fibers to the brushite-forming CPC (up to 7.5% (w/w)) only transiently delayed cell growth and did not decrease cell viability. Fiber reinforcement of CPCs thus augments their mechanical strength while preserving the injectability and biocompatibility required for their application in modern surgery., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

One key for the successful integration of implants into the human body is the control of protein adsorption by adjusting the surface properties at different length scales. This is particularly important for titanium oxide, one of the most common biomedical interfaces. As for titania (TiO(2)) the interface is largely defined by its crystal surface structure, it is crucial to understand how the surface crystallinity affects the structure, properties and function of protein layers mediating subsequent biological reactions. For rutile TiO(2) we demonstrate that the conformation and relative amount of human plasma fibrinogen (HPF) and the structure of adsorbed HPF layers depend on the crystal surface nanostructure by employing thermally etched multi-faceted TiO(2) surfaces. Thermal etching of polycrystalline TiO(2) facilitates a nanoscale crystal faceting and, thus, the creation of different surface nanostructures on a single specimen surface. Atomic force microscopy shows that HPF arranges into networks and thin globular layers on flat and irregular crystal grain surfaces, respectively. On a third, faceted category we observed an alternating conformation of HPF on neighboring facets. The bulk grain orientation obtained from electron backscatter diffraction and thermodynamic mechanisms of surface reconstruction during thermal etching suggest that the grain and facet surface-specific arrangement and relative amount of adsorbed proteins depend on the associated free crystal surface energy. The implications for potentially favorable TiO(2) crystal facets regarding the inflammatory response and hemostasis are discussed with a view to the advanced surface design of future implants., (Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Advances have been achieved in the design and biomechanical performance of orthopedic implants in the last decades. These include anatomically shaped and angle-stable implants for fracture fixation or improved biomaterials (e.g. ultra-high-molecular-weight polyethylene) in total joint arthroplasty. Future modifications need to address the biological function of implant surfaces. Functionalized surfaces can promote or reduce osseointegration, avoid implant-related infections or reduce osteoporotic bone loss. To this end, polyelectrolyte multilayer structures have been developed as functional coatings and intensively tested in vitro previously. Nevertheless, only a few studies address the effect of polyelectrolyte multilayer coatings of biomaterials in vivo. The aim of the present work is to evaluate the effect of polyelectrolyte coatings of titanium alloy implants on implant anchorage in an animal model. We test the hypotheses that (1) polyelectrolyte multilayers have an effect on osseointegration in vivo; (2) multilayers of chitosan/hyaluronic acid decrease osteoblast proliferation compared to native titanium alloy, and hence reduce osseointegration; (3) multilayers of chitosan/gelatine increase osteoblast proliferation compared to native titanium alloy, hence enhance osseointegration. Polyelectrolyte multilayers on titanium alloy implants were fabricated by a layer-by-layer self-assembly process. Titanium alloy (Ti) implants were alternately dipped into gelatine (Gel), hyaluronic acid (HA) and chitosan (Chi) solutions, thus assembling a Chi/Gel and a Chi/HA coating with a terminating layer of Gel or HA, respectively. A rat tibial model with bilateral placement of titanium alloy implants was employed to analyze the bones' response to polyelectrolyte surfaces in vivo. 48 rats were randomly assigned to three groups of implants: (1) native titanium alloy (control), (2) Chi/Gel and (3) Chi/HA coating. Mechanical fixation, peri-implant bone area and bone contact were evaluated by pull-out tests and histology at 3 and 8 weeks. Shear strength at 8 weeks was statistically significantly increased (p<0.05) in both Chi/Gel and Chi/HA groups compared to the titanium alloy control. No statistically significant difference (p>0.05) in bone contact or bone area was found between all groups. No decrease of osseointegration of Chi/HA-coated implants compared to non-coated implants was found. The results of polyelectrolyte coatings in a rat model showed that the Chi/Gel and Chi/HA coatings have a positive effect on mechanical implant anchorage in normal bone., (Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

The relationship between electric charge at a material surface and protein adsorption is essential to understand the mechanism of biological integration of materials with tissues. This study investigated the influence of titanium thin films' surface chemistry and surface electric charge (zeta-potential) properties on protein adsorption and cell proliferation. Titanium thin films were surface functionalized with different functional end groups, such as -CH=CH2, -NH2 and -COOH groups in order to produce surfaces with a variety of electric charge properties. The chemical compositions, electric charges and wettability were investigated by using X-ray photoelectron spectroscopy (XPS), zeta-potential measurements and water contact angle measurements, respectively. XPS revealed the surface functionalization of titanium films with -CH=CH2, -NH2, and -COOH groups, which were converted from -CH=CH2 groups. Ti-COOH samples showed the lowest water contact angles and zeta-potential compared to all other samples investigated in this study. NH2-terminated titanium films displayed intermediate contact angles of 70.3+/-2.5 degrees . Fibrinogen adsorption on titanium films and surface functionalized titanium films were investigated in this study. Ti-COOH samples displayed a lower protein adsorption than all other groups, such as NH2-, -CH=CH2-terminated titanium thin films. A tendency that the lower zeta-potential of the samples, the lower the protein adsorption at their surfaces was observed. In vitro cell proliferation tests were also performed on the different surface functionalized titanium films. NH2-terminated titanium films displayed good cell proliferation and cell viability tendency. However, a lower cell proliferation on COOH-terminated titanium films was observed compared with NH2-terminated titanium films. This effect was attributed to the difference in protein adsorption of these samples.

To investigate the influence of titanium films with nanometre scale topography on protein adsorption and cell growth, three different model titanium films were utilized in the present study. The chemical compositions, surface topographies and wettability were investigated by using X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM) and water contact angle measurement, respectively. The films share the same surface chemistry but exhibit different topographies on a nanometre scale. Thus, they act as model systems for biological studies regarding surface topography effects. The films were obtained by varying the deposition rate and the film thickness, respectively. These films displayed nanometre scale surface roughness (root mean square roughness, R(rms)) from 2 to 21 nm over areas of 50 microm x 50 microm, with different grain sizes at their surfaces. Albumin and fibrinogen adsorption on these model titanium films were performed in this study. Bicinchoninic acid assay was employed to determine the amount of adsorbed protein on titanium film surfaces. No statistically significant differences, however, were observed for either albumin or fibrinogen adsorption between the different groups of titanium films. No statistically significant influence of surface roughness on osteoblast proliferation and cell viability was detected in the present study.

The current "Energy Crisis" has dramatically increased our potential need for coal, the worlds most abundant fossil fuel. This will probably lead to a greater use of automation and instrumentation in the coal mining industry. The presence of methane in coal mines and in the coal itself plus the presence of coal dust, both of which can form an explosive atmosphere in air, means that the possibility of a gas or coal dust ignition must be considered when designing, purchasing and installing new equipment in this industry. In addition, many metallurgical processes involve the use of potentially explosive substances against which similar safety precautions must be taken. This paper outlines the various methods of protection currently in use and proposed for electrical instruments in explosive atmospheres, with particular emphasis on the work of the International Electrotechnical Commission.