Multiple sclerosis health-related quality of life utility values from the UK MS register

Background

New interventions for multiple sclerosis (MS) commonly require a demonstration of cost-effectiveness using health-related quality of life (HRQoL) utility values. The EQ-5D is the utility measure approved for use in the UK NHS funding decision-making. There are also MS-specific utility measures - e.g., MS Impact Scale Eight Dimensions (MSIS-8D) and MSIS-8D-Patient (MSIS-8D-P).

Objectives

Provide EQ-5D, MSIS-8D and MSIS-8D-P utility values from a large UK MS cohort and investigate their association with demographic/clinical characteristics.

Methods

UK MS Register data from 14,385 respondents (2011 to 2019) were analysed descriptively and using multivariable linear regression, with self-report Expanded Disability Status Scale (EDSS) scores.

Results

The EQ-5D and MSIS-8D were both sensitive to differences in demographic/clinical characteristics. An inconsistency found in previous studies whereby mean EQ-5D values were higher for an EDSS score of 4 rather than 3 was not observed. Similar utility values were observed between MS types at each EDSS score. Regression showed EDSS score and age were associated with utility values from all three measures.

Conclusions

This study provides generic and MS-specific utility values for a large UK MS sample, with the potential for use in cost-effectiveness analyses of treatments for MS.

Human-Centered Design to Address Biases in Artificial Intelligence

The potential of artificial intelligence (AI) to reduce health care disparities and inequities is recognized, but it can also exacerbate these issues if not implemented in an equitable manner. This perspective identifies potential biases in each stage of the AI life cycle, including data collection, annotation, machine learning model development, evaluation, deployment, operationalization, monitoring, and feedback integration. To mitigate these biases, we suggest involving a diverse group of stakeholders, using human-centered AI principles. Human-centered AI can help ensure that AI systems are designed and used in a way that benefits patients and society, which can reduce health disparities and inequities. By recognizing and addressing biases at each stage of the AI life cycle, AI can achieve its potential in health care.

Computerization of the Work of General Practitioners: Mixed Methods Survey of Final-Year Medical Students in Ireland

BACKGROUND

The potential for digital health technologies, including machine learning (ML)-enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics.

OBJECTIVE

We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks.

METHODS

Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses.

RESULTS

In total, 43.1% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs.

CONCLUSIONS

We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow's doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow's patients.

Enhancement of Ultrasound B-Mode Image Quality Using Nonlinear Filtered-Multiply-and-Sum Compounding for Improved Carotid Artery Segmentation

In ultrasound B-mode imaging, the axial resolution (AR) is commonly determined by the duration or bandwidth of an excitation signal. A shorter-duration pulse will produce better resolution compared to a longer one but with compromised penetration depth. Instead of relying on the pulse duration or bandwidth to improve the AR, an alternative method termed filtered multiply and sum (FMAS) has been introduced in our previous work. For spatial-compounding, FMAS uses the autocorrelation technique as used in filtered-delay multiply and sum (FDMAS), instead of conventional averaging. FMAS enables a higher frame rate and less computational complexity than conventional plane-wave compound imaging beamformed with delay and sum (DAS) and FDMAS. Moreover, it can provide an improved contrast ratio and AR. In previous work, no explanation was given on how FMAS was able to improve the AR. Thus, in this work, we discuss in detail the theory behind the proposed FMAS algorithm and how it is able to improve the spatial resolution mainly in the axial direction. Simulations, experimental phantom measurements and in vivo studies were conducted to benchmark the performance of the proposed method. We also demonstrate how the suggested new algorithm may be used in a practical biomedical imaging application. The balloon snake active contour segmentation technique was applied to the ultrasound B-mode image of a common carotid artery produced with FMAS. The suggested method is capable of reducing the number of iterations for the snake to settle on the region-of-interest contour, accelerating the segmentation process.

Biodegradable Biopolymeric Nanoparticles for Biomedical Applications-Challenges and Future Outlook

Biopolymers are polymers obtained from either renewable or non-renewable sources and are the most suitable candidate for tailor-made nanoparticles owing to their biocompatibility, biodegradability, low toxicity and immunogenicity. Biopolymeric nanoparticles (BPn) can be classified as natural (polysaccharide and protein based) and synthetic on the basis of their origin. They have been gaining wide interest in biomedical applications such as tissue engineering, drug delivery, imaging and cancer therapy. BPn can be synthesized by various fabrication strategies such as emulsification, ionic gelation, nanoprecipitation, electrospray drying and so on. The main aim of the review is to understand the use of nanoparticles obtained from biodegradable biopolymers for various biomedical applications. There are very few reviews highlighting biopolymeric nanoparticles employed for medical applications; this review is an attempt to explore the possibilities of using these materials for various biomedical applications. This review highlights protein based (albumin, gelatin, collagen, silk fibroin); polysaccharide based (chitosan, starch, alginate, dextran) and synthetic (Poly lactic acid, Poly vinyl alcohol, Poly caprolactone) BPn that has recently been used in many applications. The fabrication strategies of different BPn are also being highlighted. The future perspective and the challenges faced in employing biopolymeric nanoparticles are also reviewed.

The added value of applying a disinvestment approach to the process of health technology assessment in Italy

OBJECTIVES

The objective of the present policy analysis was to understand how a disinvestment approach to the process of health technology assessment (HTA), applied to the field of medical devices, might help Italian policymakers to properly spend the resources in healthcare.

METHODS

Previous international and national experiences in disinvestment for medical devices were reviewed. Precious insights for the rational expenditure of the resources were derived by assessing the evidence available.

RESULTS

The disinvestment of ineffective or inappropriate technologies or interventions with an inadequate value-for-money ratio has become a growing priority for National Health Systems. Different international disinvestment experiences of medical devices were identified and described through a rapid review. Although most of them have a strong theoretical framework, their practical application remains difficult. In Italy, there are no examples of large and complex HTA-based disinvestment practices, but their importance is becoming increasingly acknowledged, especially given the need to prioritize the funds provided by Recovery and Resilience Plan.

CONCLUSIONS

Anchoring decisions on health technologies without reassessing the current technological landscape through a robust HTA model might expose to the risk of not ensuring the best employment of the resources available. Thus, it is necessary to develop a strong HTA ecosystem in Italy through adequate consultation with stakeholders to enable a data-driven and evidence-based prioritization of resources toward choices characterized by high value for both patients and society as a whole.

A Comprehensive Review on Barium Titanate Nanoparticles as a Persuasive Piezoelectric Material for Biomedical Applications: Prospects and Challenges

Stimulation of cells with electrical cues is an imperative approach to interact with biological systems and has been exploited in clinical practices over a wide range of pathological ailments. This bioelectric interface has been extensively explored with the help of piezoelectric materials, leading to remarkable advancement in the past two decades. Among other members of this fraternity, colloidal perovskite barium titanate (BaTiO₃ ) has gained substantial interest due to its noteworthy properties which includes high dielectric constant and excellent ferroelectric properties along with acceptable biocompatibility. Significant progression is witnessed for BaTiO₃ nanoparticles (BaTiO₃ NPs) as potent candidates for biomedical applications and in wearable bioelectronics, making them a promising personal healthcare platform. The current review highlights the nanostructured piezoelectric bio interface of BaTiO₃ NPs in applications comprising drug delivery, tissue engineering, bioimaging, bioelectronics, and wearable devices. Particular attention has been dedicated toward the fabrication routes of BaTiO₃ NPs along with different approaches for its surface modifications. This review offers a comprehensive discussion on the utility of BaTiO₃ NPs as active devices rather than passive structural unit behaving as carriers for biomolecules. The employment of BaTiO₃ NPs presents new scenarios and opportunity in the vast field of nanomedicines for biomedical applications.

Activity Regulating Strategies of Nanozymes for Biomedical Applications

On accounts of the advantages of inherent high stability, ease of preparation and superior catalytic activities, nanozymes have attracted tremendous potential in diverse biomedical applications as alternatives to natural enzymes. Optimizing the activity of nanozymes is significant for widening and boosting the applications into practical level. As the research of the catalytic activity regulation strategies of nanozymes is boosting, it is essential to timely review, summarize, and analyze the advances in structure-activity relationships for further inspiring ingenious research into this prosperous area. Herein, the activity regulation methods of nanozymes in the recent 5 years are systematically summarized, including size and morphology, doping, vacancy, surface modification, and hybridization, followed by a discussion of the latest biomedical applications consisting of biosensing, antibacterial, and tumor therapy. Finally, the challenges and opportunities in this rapidly developing field is presented for inspiring more and more research into this infant yet promising area.

Multimodal Raman spectroscopy and optical coherence tomography for biomedical analysis

Optical techniques hold great potential to detect and monitor disease states as they are a fast, non-invasive toolkit. Raman spectroscopy (RS) in particular is a powerful label-free method capable of quantifying the biomolecular content of tissues. Still, spontaneous Raman scattering lacks information about tissue morphology due to its inability to rapidly assess a large field of view. Optical Coherence Tomography (OCT) is an interferometric optical method capable of fast, depth-resolved imaging of tissue morphology, but lacks detailed molecular contrast. In many cases, pairing label-free techniques into multimodal systems allows for a more diverse field of applications. Integrating RS and OCT into a single instrument allows for both structural imaging and biochemical interrogation of tissues and therefore offers a more comprehensive means for clinical diagnosis. This review summarizes the efforts made to date toward combining spontaneous RS-OCT instrumentation for biomedical analysis, including insights into primary design considerations and data interpretation.

Organ-on-a-chip technologies for biomedical research and drug development: A focus on the vasculature

Current biomedical models fail to replicate the complexity of human biology. Consequently, almost 90% of drug candidates fail during clinical trials after decades of research and billions of investments in drug development. Despite their physiological similarities, animal models often misrepresent human responses, and instead, trigger ethical and societal debates regarding their use. The overall aim across regulatory entities worldwide is to replace, reduce, and refine the use of animal experimentation, a concept known as the Three Rs principle. In response, researchers develop experimental alternatives to improve the biological relevance of in vitro models through interdisciplinary approaches. This article highlights the emerging organ-on-a-chip technologies, also known as microphysiological systems, with a focus on models of the vasculature. The cardiovascular system transports all necessary substances, including drugs, throughout the body while in charge of thermal regulation and communication between other organ systems. In addition, we discuss the benefits, limitations, and challenges in the widespread use of new biomedical models. Coupled with patient-derived induced pluripotent stem cells, organ-on-a-chip technologies are the future of drug discovery, development, and personalized medicine.

Porous Structural Microfluidic Device for Biomedical Diagnosis: A Review

Microfluidics has recently received more and more attention in applications such as biomedical, chemical and medicine. With the development of microelectronics technology as well as material science in recent years, microfluidic devices have made great progress. Porous structures as a discontinuous medium in which the special flow phenomena of fluids lead to their potential and special applications in microfluidics offer a unique way to develop completely new microfluidic chips. In this article, we firstly introduce the fabrication methods for porous structures of different materials. Then, the physical effects of microfluid flow in porous media and their related physical models are discussed. Finally, the state-of-the-art porous microfluidic chips and their applications in biomedicine are summarized, and we present the current problems and future directions in this field.

Circulatory Support: Artificial Muscles for the Future of Cardiovascular Assist Devices

Artificial muscles enable the design of soft implantable devices which are poised to transform the way we mechanically support the heart today. Heart failure is a prevalent and deadly disease, which is treated with the implantation of rotary blood pumps as the only alternative to heart transplantation. The clinically used mechanical devices are associated with severe adverse events, which are reflected here in a comprehensive list of critical requirements for soft active devices of the future: low power, no blood contact, pulsatile support, physiological responsiveness, high cycle life, and less-invasive implantation. In this review, we investigate and critically evaluate prior art in artificial muscles for their applicability in the short and long term. We highlight the main challenges regarding the effectiveness, controllability, and implantability of recently proposed actuators and explore future perspectives for attachment, physiological responsiveness, durability, and biodegradability as well as equitable design considerations. This article is protected by copyright. All rights reserved.

Bioimaging Probes Based on Magneto-Fluorescent Nanoparticles

Novel nanomaterials are of interest in biology, medicine, and imaging applications. Multimodal fluorescent-magnetic nanoparticles demand special attention because they have the potential to be employed as diagnostic and medication-delivery tools, which, in turn, might make it easier to diagnose and treat cancer, as well as a wide variety of other disorders. The most recent advancements in the development of magneto-fluorescent nanocomposites and their applications in the biomedical field are the primary focus of this review. We describe the most current developments in synthetic methodologies and methods for the fabrication of magneto-fluorescent nanocomposites. The primary applications of multimodal magneto-fluorescent nanoparticles in biomedicine, including biological imaging, cancer treatment, and drug administration, are covered in this article, and an overview of the future possibilities for these technologies is provided.

Facile Synthesis of Magnetic Nigella Sativa Seeds: Advances on Nano-Formulation Approaches for Delivering Antioxidants and Their Antifungal Activity against Candida albicans

This article reports on incorporating magnetic nanoparticles into natural carbon frameworks derived from Nigella Sativa seeds and their synthesis via co-precipitation reactions for application in biomedicine. The magnetic Nigella Sativa Seeds (Magnetic NSS), a metal oxide-based bio-nanomaterial, has shown excellent water diaper presence due to the presence of a wide range of oxygenous hydroxyl and carboxyl groups. The physicochemical properties of the composites were characterized extensively using Fourier transform infrared spectroscopy (FTIR), powder-X-ray diffraction (XRD), scanning electron microscopy (SEM), elemental analysis, transmission electron microscopy (TEM), and vibrating-sample magnetometer. Furthermore, synthesized magnetic NSS showed antioxidant and antifungal activity. The antifungal susceptibility was further tested against Candida albicans with a MIC value of 3.125 µg/mL. Analysis of antioxidant defense enzymes was determined quantitatively; the results suggested that antioxidant enzyme activity increase with increased magnetic NSS concentration. Furthermore, biofilm inhibition assay from scanning electron microscopy results revealed that magnetic NSS at the concentration of 3.5 μg/mL has anti-biofilm properties and can disrupt membrane integrity.

Evaluating Hydroxyapatite, Gold Nanoparticles, and Graphene-Copper as Bimodal Agents for X-ray and Computed Tomography

A global need exists for new and more effective contrast agents for computed tomography and traditional X-ray modalities. Among the few options available nowadays, limitations imposed by industrial production, performance, and efficacy restrict the use and reduce the potential of both imaging techniques. The use of nanomaterials as new contrast agents for X-ray and computed tomography is an innovative and viable way to increase the options and enhance performance. In this study, we evaluated eight nanomaterials: hydroxyapatite doped with zinc (Zn-HA 10%); hydroxyapatite doped with strontium (Sr-HA 10%); hydroxyapatite without thermal treatment (HA 282 STT); thermally treated hydroxyapatite (HA 212 500 °C and HA 01.256 CTT 1000 °C); hydroxyapatite microspheres (HA microspheres); gold nanoparticles (AuNP); and graphene oxide doped with copper (Cu-GO). The results showed that for both imaging modalities; HA microspheres were the best option, followed by hydroxyapatite thermally treated at 1000 °C. The nanomaterials with the worst results were hydroxyapatite doped with zinc (Zn-HA 10%), and hydroxyapatite doped with strontium (Sr-HA 10%). Our data demonstrated the potential of using nanomaterials, especially HA microspheres, and hydroxyapatite with thermal treatment (HA 01.256 CTT 1000 °C) as contrast agents for X-ray and computed tomography.

A DR/NIR Hybrid Polymeric Tool for Functional Bio-Coatings: Theoretical Study, Cytotoxicity, and Antimicrobial Activity

Among modern biomaterials, hybrid tools containing an organic component and a metal cation are recognized as added value, and, for many advanced biomedical applications, synthetic polymers are used as thin protective/functional coatings for medical or prosthetic devices and implants. These materials require specific non-degradability, biocompatibility, antimicrobial, and antiproliferative properties to address safety aspects concerning their use in medicine. Moreover, bioimaging monitoring of the biomedical device and/or implant through biological tissues is a desirable ability. This article reports a novel hybrid metallopolymer obtained by grafting zinc-coordinated fragments to an organic polymeric matrix. This hybrid polymer, owing to its relevant emission in the deep red to near-infrared (DR/NIR) region, is monitorable; therefore, it represents a potential material for biomedical coating. Furthermore, it shows good biocompatibility and adhesion properties and excellent stability in slightly acidic/basic water solutions. Finally, in contact with the superficial layers of human skin, it shows antimicrobial properties against Staphylococcus aureus bacterial strains.

[Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology AssessmentSíntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina]

This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

Recent Progress in Proteins-Based Micelles as Drug Delivery Carriers

Proteins-derived polymeric micelles have gained attention and revolutionized the biomedical field. Proteins are considered a favorable choice for developing micelles because of their biocompatibility, harmlessness, greater blood circulation and solubilization of poorly soluble drugs. They exhibit great potential in drug delivery systems as capable of controlled loading, distribution and function of loaded agents to the targeted sites within the body. Protein micelles successfully cross biological barriers and can be incorporated into various formulation designs employed in biomedical applications. This review emphasizes the recent advances of protein-based polymeric micelles for drug delivery to targeted sites of various diseases. Most studied protein-based micelles such as soy, gelatin, casein and collagen are discussed in detail, and their applications are highlighted. Finally, the future perspectives and forthcoming challenges for protein-based polymeric micelles have been reviewed with anticipated further advances.

The 11th Canadian Symposium on Hepatitis C Virus: 'Getting back on track towards hepatitis C elimination'

Hepatitis C virus (HCV) affects approximately 204,000 Canadians. Safe and effective direct-acting antiviral therapies have contributed to decreased rates of chronic HCV infection and increased treatment uptake in Canada, but major challenges for HCV elimination remain. The 11th Canadian Symposium on Hepatitis C Virus took place in Ottawa, Ontario on May 13, 2022 as a hybrid conference themed 'Getting back on track towards hepatitis C elimination.' It brought together research scientists, clinicians, community health workers, patient advocates, community members, and public health officials to discuss priorities for HCV elimination in the wake of the COVID-19 pandemic, which had devastating effects on HCV care in Canada, particularly on priority populations. Plenary sessions showcased topical research from prominent international and national researchers, complemented by select abstract presentations. This event was hosted by the Canadian Network on Hepatitis C (CanHepC), with support from the Public Health Agency of Canada and the Canadian Institutes of Health Research and in partnership with the Canadian Liver Meeting. CanHepC has an established record in HCV research and in advocacy activities to address improved diagnosis and treatment, and immediate and long-term needs of those affected by HCV infection. The Symposium addressed the remaining challenges and barriers to HCV elimination in priority populations and principles for meaningful engagement of Indigenous communities and individuals with living and lived experience in HCV research. It emphasized the need for disaggregated data and simplified pathways for creating and monitoring interventions for equitably achieving elimination targets.

Genomic and proteomic findings in early melanoma and opportunities for early diagnosis

Overdiagnosis of early melanoma is a significant problem. Due to subtle unique and overlapping clinical and histological criteria between pigmented lesions and the risk of mortality from melanoma, some benign pigmented lesions are diagnosed as melanoma. Although histopathology is the gold standard to diagnose melanoma, there is a demand to find alternatives that are more accurate and cost-effective. In the current "omics" era, there is gaining interest in biomarkers to help diagnose melanoma early and to further understand the mechanisms driving tumor progression. Genomic investigations have attempted to differentiate malignant melanoma from benign pigmented lesions. However, genetic biomarkers of early melanoma diagnosis have not yet proven their value in the clinical setting. Protein biomarkers may be more promising since they directly influence tissue phenotype, a result of by-products of genomic mutations, posttranslational modifications and environmental factors. Uncovering relevant protein biomarkers could increase confidence in their use as diagnostic signatures. Currently, proteomic investigations of melanoma progression from pigmented lesions are limited. Studies have previously characterised the melanoma proteome from cultured cell lines and clinical samples such as serum and tissue. This has been useful in understanding how melanoma progresses into metastasis and development of resistance to adjuvant therapies. Currently, most studies focus on metastatic melanoma to find potential drug therapy targets, prognostic factors and markers of resistance. This paper reviews recent advancements in the genomics and proteomic fields and reports potential avenues, which could help identify and differentiate melanoma from benign pigmented lesions and prevent the progression of melanoma.

Nanoparticles: Taking a Unique Position in Medicine

The human nature of curiosity, wonder, and ingenuity date back to the age of humankind. In parallel with our history of civilization, interest in scientific approaches to unravel mechanisms underlying natural phenomena has been developing. Recent years have witnessed unprecedented growth in research in the area of pharmaceuticals and medicine. The optimism that nanotechnology (NT) applied to medicine and drugs is taking serious steps to bring about significant advances in diagnosing, treating, and preventing disease-a shift from fantasy to reality. The growing interest in the future medical applications of NT leads to the emergence of a new field for nanomaterials (NMs) and biomedicine. In recent years, NMs have emerged as essential game players in modern medicine, with clinical applications ranging from contrast agents in imaging to carriers for drug and gene delivery into tumors. Indeed, there are instances where nanoparticles (NPs) enable analyses and therapies that cannot be performed otherwise. However, NPs also bring unique environmental and societal challenges, particularly concerning toxicity. Thus, clinical applications of NPs should be revisited, and a deep understanding of the effects of NPs from the pathophysiologic basis of a disease may bring more sophisticated diagnostic opportunities and yield more effective therapies and preventive features. Correspondingly, this review highlights the significant contributions of NPs to modern medicine and drug delivery systems. This study also attempted to glimpse the future impact of NT in medicine and pharmaceuticals.

Silk Fibroin-Based Piezoelectric Sensor with Carbon Nanofibers for Wearable Health Monitoring Applications

The continuous real-time monitoring of human health using biomedical sensing devices has recently become a promising approach to the realization of distant health monitoring. In this paper, the piezoelectric characteristics of the silk fibroin (SF) natural polymer were analyzed as the material used for obtaining sensing information in the application of distance health monitoring. To enhance the SF piezoelectricity, this paper presents the development of a novel SF-based sensor realized by combining SF with different carbon nanofiber (CNF) densities, and for such newly developed SF-based sensors comprehensive performance analyses have been performed. Versatile methods including the scanning electron microscope, Fourier transform infrared spectroscopy, Raman and X-ray diffraction measurements and impedance analysis were used to study the morphologic, mechanical and electrical properties of the developed SF-based sensor. The SF with CNF samples was analyzed for three different pressure loads (40 N, 60 N and 80 N) in 500 compression test cycles. The analyses thoroughly describe how combining natural polymer SF with different CNF densities impacts the piezoelectricity and mechanical strength of the proposed SF-based sensor. The developed piezoelectric SF-based sensors were further tested on humans in real medical applications to detect generated piezoelectric voltage in versatile body movements. The maximum piezoelectricity equal to 2.95 ± 0.03 V was achieved for the jumping movement, and the SF sample with a CNF density equal to 0.4% was tested. Obtained results also show that the proposed SF-based sensor has an appropriate piezoelectric sensitivity for each of the analyzed body movement types, and that the proposed SF-based sensor can be applied in real medical applications as a biomedical sensing device. The proposed SF-based sensor's practical implementation is further confirmed by the results of cytotoxicity analyses, which show that the developed sensor has a non-toxic and biocompatible nature and can be efficiently used in skin contact for biomedical wearable health monitoring applications.

Regenerated silk fibroin loaded with natural additives: a sustainable approach towards health care

According to World Health Organization (WHO), on average, 0.5 Kg of hazardous waste is generated per bed every day in high-income countries. The adverse effects imposed by synthetic materials and chemicals on the environment and humankind have urged researchers to explore greener technologies and materials. Amidst of all the natural fibers, silk fibroin (SF), by virtue of its superior toughness (6 × 10⁴∼16 × 10⁴ J/kg), tensile strength (47.2-67.7 MPa), tunable biodegradability, excellent Young's modulus (1.9-3.9 GPa), presence of functional groups, ease of processing, and biocompatibility has garnered an enormous amount of scientific interests. The use of silk fibroin conjoint with purely natural materials can be an excellent solution for the adverse effects of chemical-based treatment techniques. Considering this noteworthiness, vigorous research is going on in silk-based biomaterials, and it is opening up new vistas of opportunities. This review enswathes the structural aspects of silk fibroin along with its potency to form composites with other natural materials, such as curcumin, keratin, alginate, hydroxyapatite, hyaluronic acid, and cellulose, that can replace the conventionally used synthetic materials, providing a sustainable pathway to biomedical engineering. It was observed that a large amount of polar functional moieties present on the silk fibroin surface enables them to compatibilize easily with the natural additives. The conjunction of silk with natural additives initiates synergistic interactions that mitigate the limitations offered by individual units as well as enhance the applicability of materials. Further the current status and challenges in the commercialization of silk-based biomedical devices are discussed.

Plasma Surface Engineering of Natural and Sustainable Polymeric Derivatives and Their Potential Applications

Recently, natural as well as synthetic polymers have been receiving significant attention as candidates to replace non-renewable materials. With the exponential developments in the world each day, the collateral damage to the environment is incessant. Increased demands for reducing pollution and energy consumption are the driving force behind the research related to surface-modified natural fibers (NFs), polymers, and various derivatives of them such as natural-fiber-reinforced polymer composites. Natural fibers have received special attention for industrial applications due to their favorable characteristics, such as low cost, abundance, light weight, and biodegradable nature. Even though NFs offer many potential applications, they still face some challenges in terms of durability, strength, and processing. Many of these have been addressed by various surface modification methodologies and compositing with polymers. Among different surface treatment strategies, low-temperature plasma (LTP) surface treatment has recently received special attention for tailoring surface properties of different materials, including NFs and synthetic polymers, without affecting any of the bulk properties of these materials. Hence, it is very important to get an overview of the latest developments in this field. The present article attempts to give an overview of different materials such as NFs, synthetic polymers, and composites. Special attention was placed on the low-temperature plasma-based surface engineering of these materials for diverse applications, which include but are not limited to environmental remediation, packaging, biomedical devices, and sensor development.