High cycle fatigue behavior of implant Ti-6Al-4V in air and simulated body fluid.

Ti-6Al-4V implants that function as artificial joints are usually subjected to long-term cyclic loading. To study long-term fatigue behaviors of implant Ti-6Al-4V in vitro and in vivo conditions exceeding 107 cycles, constant stress amplitude fatigue experiments were carried out at ultrasonic frequency (20 kHz) with two different surface conditions (ground and polished) in ambient air and in a simulated body fluid. The initiation mechanisms of fatigue cracks were investigated with scanning electron microscopy. Improvement of fatigue strength is pronounced for polished specimens below 106 cycles in ambient air since fatigue cracks are initiated from surfaces of specimens. While the cycles exceed 106, surface conditions have no effect on fatigue behaviors because the defects located within the specimens become favorable sites for crack initiation. The endurance limit at 108 cycles of polished Ti-6Al-4V specimens decreases by 7% if it is cycled in simulated body fluid instead of ambient air. Fracture surfaces show that fatigue failure is initiated from surfaces in simulated body fluid. Surface improvement has a beneficial effect on fatigue behaviors of Ti-6Al-4V at high stress amplitudes. The fatigue properties of Ti-6Al-4V deteriorate and the mean endurance limits decrease significantly in simulated body fluid.

Can baseline magnetic resonance angiography (MRA) status become a foremost factor in selecting optimal acute stroke patients for recombinant tissue plasminogen activator (rt-PA) thrombolysis beyond 3 hours?

OBJECTIVE: We investigated whether baseline vessel status evaluated by magnetic resonance angiography (MRA) can be the foremost factor to classify acute ischemic stroke patients into subgroups for thrombolytic therapy within 3-6 hours of symptom onset. METHODS: Acute ischemic stroke patients beyond 3 hours after symptom onset were examined by stroke magnetic resonance imaging (MRI) (diffusion- and perfusion-weighted imaging, and MRA) before and after thrombolysis treatment within 24-48 hours. Stroke MRI was used to classify acute ischemic stroke patients into subgroups and select optimal patients for thrombolytic treatment. Clinical scores were compared to determine whether there were significant differences among subgroups. RESULTS: The difference in day 90 modified Rankin scale (mRS) between treated salvageable and untreated salvageable patients with recombinant tissue plasminogen activator (rt-PA) was remarkably statistically significant (p=0.02). Treated salvageable patients had more favorable clinical outcomes as compared with the untreated salvageable patients. Patients who did not have baseline artery occlusion were associated with more favorable clinical outcomes than untreated salvageable patients (p<0.001). The difference between treated salvageable and patients without artery occlusion in 90 day mRS score was not statistically significant (p=0.058). CONCLUSION: Baseline vessel status evaluated by MRA may be used as the first factor ahead of mismatch to categorize acute ischemic stroke patients into subgroups. Patients who do not have initial vessel occlusion may not need thrombolytic therapy.