Rare giant inguinal hernia causing end-stage dialysis-dependent renal failure.

A 72-year-old man presented with urinary retention, weight loss, haematuria and severe acute kidney injury. He had never before been admitted to hospital and his past medical history included only an inguinal hernia. On examination, he appeared uraemic and had a right-sided painful hernia. A three-way catheter was inserted, bladder washouts performed and irrigation started. An ultrasound showed severe bilateral hydronephrosis and a 'thickened bladder' and this was thought to be obstructive uropathy secondary to bladder cancer. Twenty-four hours later his hernia doubled in diameter, became incarcerated and a CT of the abdomen and pelvis showed an inguinal hernia of both bladder and bowel, with the catheter tip inside the bladder hernia. He was taken to theatres and an open mesh repair was performed with a rigid cystoscopy to assist in locating and reducing the bladder. He required intensive care and dialysis postoperatively and remains on regular dialysis following discharge.

Mesenchymal stem cell responses to bone-mimetic electrospun matrices composed of polycaprolactone, collagen I and nanoparticulate hydroxyapatite.

The performance of biomaterials designed for bone repair depends, in part, on the ability of the material to support the adhesion and survival of mesenchymal stem cells (MSCs). In this study, a nanofibrous bone-mimicking scaffold was electrospun from a mixture of polycaprolactone (PCL), collagen I, and hydroxyapatite (HA) nanoparticles with a dry weight ratio of 50/30/20 respectively (PCL/col/HA). The cytocompatibility of this tri-component scaffold was compared with three other scaffold formulations: 100% PCL (PCL), 100% collagen I (col), and a bi-component scaffold containing 80% PCL/20% HA (PCL/HA). Scanning electron microscopy, fluorescent live cell imaging, and MTS assays showed that MSCs adhered to the PCL, PCL/HA and PCL/col/HA scaffolds, however more rapid cell spreading and significantly greater cell proliferation was observed for MSCs on the tri-component bone-mimetic scaffolds. In contrast, the col scaffolds did not support cell spreading or survival, possibly due to the low tensile modulus of this material. PCL/col/HA scaffolds adsorbed a substantially greater quantity of the adhesive proteins, fibronectin and vitronectin, than PCL or PCL/HA following in vitro exposure to serum, or placement into rat tibiae, which may have contributed to the favorable cell responses to the tri-component substrates. In addition, cells seeded onto PCL/col/HA scaffolds showed markedly increased levels of phosphorylated FAK, a marker of integrin activation and a signaling molecule known to be important for directing cell survival and osteoblastic differentiation. Collectively these results suggest that electrospun bone-mimetic matrices serve as promising degradable substrates for bone regenerative applications.

In vitro dissolution and mechanical behavior of c-axis preferentially oriented hydroxyapatite thin films fabricated by pulsed laser deposition.

Owing to its resemblance to the major inorganic constituent of bone and tooth, hydroxyapatite is recognized as one of the most biocompatible materials and is widely used in systems for bone replacement and regeneration. In this study the pulsed laser deposition technique was chosen to produce hydroxyapatite with different crystallographic orientations in order to investigate some of the material properties, including its in vitro dissolution behavior, as well as mechanical properties. The crystallographic orientations of hydroxyapatite coatings can be carefully controlled, mainly by varying the energy density of the KrF excimer laser (248 nm) used for deposition. Nanoindentation results showed that highly c-axis oriented hydroxyapatite coatings have higher hardness and Young's modulus values compared with the values of randomly oriented coatings. After 24h immersion in simulated physiological solution the overall surface morphology of the highly oriented coatings was dramatically altered. The porosity was drastically increased and sub-micron pores were formed throughout the coatings, whereas the average size of the grains in the coatings was not significantly changed. The composition of the textured hydroxyapatite coatings remained essentially unchanged. Their c-axis texture, on the other hand, was rather enhanced with an increase in immersion time. The c-axis oriented hydroxyapatite surfaces are likely to promote preferentially oriented growth through a cyclic process of dissolution and reprecipitation, followed by homoepitaxial growth. The remarkable morphological and microstructural changes after dissolution suggest a capability of highly textured hydroxyapatite as a tissue engineering scaffold with an interconnecting porous network that may be beneficial for cellular activity.

Mesenchymal stem cell interaction with ultra-smooth nanostructured diamond for wear-resistant orthopaedic implants.

Ultra-smooth nanostructured diamond (USND) can be applied to greatly increase the wear resistance of orthopaedic implants over conventional designs. Herein we describe surface modification techniques and cytocompatibility studies performed on this new material. We report that hydrogen (H)-terminated USND surfaces supported robust mesenchymal stem cell (MSC) adhesion and survival, while oxygen- (O) and fluorine (F)-terminated surfaces resisted cell adhesion, indicating that USND can be modified to either promote or prevent cell/biomaterial interactions. Given the favorable cell response to H-terminated USND, this material was further compared with two commonly used biocompatible metals, titanium alloy (Ti-6Al-4V) and cobalt chrome (CoCrMo). MSC adhesion and proliferation were significantly improved on USND compared with CoCrMo, although cell adhesion was greatest on Ti-6Al-4V. Comparable amounts of the pro-adhesive protein, fibronectin, were deposited from serum on the three substrates. Finally, MSCs were induced to undergo osteoblastic differentiation on the three materials, and deposition of a mineralized matrix was quantified. Similar amounts of mineral were deposited onto USND and CoCrMo, whereas mineral deposition was slightly higher on Ti-6Al-4V. When coupled with recently published wear studies, these in vitro results suggest that USND has the potential to reduce debris particle release from orthopaedic implants without compromising osseointegration.

Hydroxyapatite nanoparticle loaded collagen fiber composites: microarchitecture and nanoindentation study.

Hydroxyapatite (HA) nanoparticle-collagen composite materials with various HA/collagen weight ratios were prepared from HA/collagen dispersions using the solution deposition and electrospinning with static or rotating collectors. The composites with nanoparticle HA to collagen weight ratio of 80:20 can be easily prepared in the solution deposition approach, whereas in the electrospun fibrous composites it was possible to reach a maximum HA/collagen weight ratio of 30:70 while maintaining a good fibrous structure. The structure, surface morphology, and nanoindentation properties of these nanoparticle HA/collagen composites with different microarchitectures were investigated. The values from 0.2 GPa to 20 GPa for nanoindentation Young's modulus and from 25 MPa to 500 MPa for hardness, were obtained depending on the fabrication technique, composition, and microarchitecture of the composites. It was observed that the nanoindentation Young's modulus and hardness of the HA/collagen composite materials seem to achieve maximum values for 45-60% HA content by weight.

Preliminary tribological evaluation of nanostructured diamond coatings against ultra-high molecular weight polyethylene.

BACKGROUND: Some loss of joint prostheses has been attributed to osteolytic loosening associated with debris from wear of polyethylene articulating against metal alloys. Reduced polyethylene wear has been reported with ceramics serving as an alternative counterface. METHODS: Nanostructured Diamond (NSD) coatings were deposited onto Ti6Al4V by microwave plasma-assisted chemical vapor deposition, with both hydrogen-rich (H-NSD) and helium-rich (He-NSD) feedgas mixtures. Pin-on-disk wear tests of polyethylene against NSD and CoCr were performed in serum lubrication at body temperature. Scanning electron microscopy was used to examine surface morphology, and nanoindentation was used to determine hardness and modulus of the polyethylene wear surfaces. Raman spectroscopy, surface roughness, and wettability analyses of the NSD coatings were performed. RESULTS: Raman spectroscopy confirmed sp(2) and sp(3) bonded carbon in the NSD coatings. No significant differences in wear factors were found between polyethylene on H-NSD, He-NSD, and CoCr, despite higher roughness and friction coefficients for the He-NSD and H-NSD coatings, compared with CoCr. Contact angles for the diamond coatings were reduced following the wear tests, indicating that these surfaces became more hydrophilic. Numerous small protuberances were observed on pins articulated against CoCr, and a single, large protuberance was observed in polyethylene-on-NSD. These features were conjectured to be reconsolidated polyethylene particles. Nanoindentation modulus and hardness of the worn polyethylene surfaces were lower for polyethylene-on-diamond than for polyethylene-on-CoCr. CONCLUSIONS: As a counterface to polyethylene, NSD-coated Ti6Al4V produced wear factors comparable to CoCr in the present pin-on-disk tests, a promising step towards its use in joint replacement bearing applications.

Ultra-smooth nanostructured diamond films deposited from He/H2/CH4/N2 microwave plasmas.

Addition of He to a high CH4 content (10.7 vol%) H2/CH4/N2 feedgas mixture for microwave plasma chemical vapor deposition produced hard (58-72 GPa), ultra-smooth nanostructured diamond films on Ti-6AI-4V alloy substrates. Upon increase in He content up to 71 vol%, root mean squared (RMS) surface roughness of the film decreased to 9-10 nm and average diamond grain size to 5-6 nm. Our studies show that increased nanocrystallinity with He addition in plasma is related to plasma dilution, enhanced fragmentation of carbon containing species, and enhanced formation of CN radical.

Correlation between nitrate contamination and ground water pollution potential.

AQUIPRO, a PC-based method, was used to assess aquifer vulnerability using digital water well logs. The AQUIPRO model is a parameter/factor weighting system for rating the pollution potential of an aquifer. This method uses the well depth, as well as the clay and partial clay thickness in a well, to generate pollution potential scores. In this model, aquifer protection increases as the AQUIPRO vulnerability scores increase and ground water pollution potential decreases. Computerized water well records of 2435 domestic wells with partial chemistry data were used to determine the ground water pollution potential of Kalamazoo County, Michigan. Theoretically, low AQUIPRO pollution potential scores should have more frequent occurrences of ground water contamination events than areas with high AQUIPRO scores with similar land-use, well construction, and well densities. The relative AQUIPRO scores were compared with the frequency of occurrences of nitrate-N in ground water wells. The average nitrate-N concentrations within each relative AQUIPRO vulnerability scores category were also compared. The results indicate that domestic wells containing 5 mg/L or more nitrate-N showed a positive correlation between the frequency of occurrences of nitrate-N and relative decrease of AQUIPRO (r2 = 0.99) vulnerability scores. In other words, as the ground water pollution potential increases, the occurrence frequency of nitrate-N also increases. Furthermore, the results show that as the relative AQUIPRO (r2 = 0.96) vulnerability scores decrease, the mean nitrate-N concentrations also increase.