Effect of density grading on the mechanical behaviour of advanced functionally graded lattice structures

Lattice structures have found significant applications in the biomedical field due to their interesting combination of mechanical and biological properties. Among these, functionally graded structures sparked interest because of their potential of varying their mechanical properties throughout the volume, allowing the design of biomedical devices able to match the characteristics of a graded structure like human bone. The aim of this works is the study of the effect of the density grading on the mechanical response and the failure mechanisms of a novel functionally graded lattice structure, namely Triply Arranged Octagonal Rings (TAOR). The mechanical behaviour was compared with the same lattice structures having constant density ratio. Electron Beam Melting technology was used to manufacture titanium alloy specimens with global relative densities from 10% to 30%. Functionally graded structures were obtained by increasing the relative density along the specimen, by individually designing the lattice's layers. Scanning electron and a digital microscopy were used to evaluate the dimensional mismatch between actual and designed structures. Compressive tests were carried out to obtain the mechanical properties and to evaluate the collapse modes of the structures in relation to their average relative density and lattice grading. Open-source Digital Image Correlation algorithm was applied to evaluate the deformation behaviour of the structures and to calculate their elastic moduli. The results showed that uniform density structures provide higher mechanical properties than functionally graded ones. The Digital Image Correlation results showed the possibility of effectively designing the different layers of functionally graded structures selecting desired local mechanical properties to mimic the different characteristics of cortical and cancellous bone.

Multiscale Mechanical Characterization of Polyether-2-ketone (PEKK) for Biomedical Application

Polyether-ether-2-ketone (PEKK) is a high-performance thermoplastic polymer used in various fields, from aerospace to medical applications, due to its exceptional mechanical and thermal properties. Nonetheless, the mechanical behavior of 3D-printed PEKK still deserves to be more thoroughly investigated, especially in view of its production by 3D printing, where mechanical properties measured at different scales are likely to be correlated to one another and to all play a major role in determining biomechanical properties, which include mechanical strength on one side and osteointegration ability on the other side. This work explores the mechanical behavior of 3D-printed PEKK through a multiscale approach, having performed both nanoindentation tests and standard tensile and compression tests, where a detailed view of strain distribution was achieved through Digital Image Correlation (DIC) techniques. Furthermore, for specimens tested up to failure, their fractured surfaces were analyzed through Scanning Electron Microscopy (SEM) to clearly outline fracture modes. Additionally, the internal structure of 3D-printed PEKK was explored through Computed Tomography (CT) imaging, providing a three-dimensional view of the internal structure and the presence of voids and other imperfections. Finally, surface morphology was analyzed through confocal microscopy. The multiscale approach adopted in the present work offers information about the global and local behavior of the PEKK, also assessing its material properties down to the nanoscale. Due to its novelty as a polymeric material, no previous studies have approached a multiscale analysis of 3D-printed PEKK. The findings of this study contribute to a comprehensive understanding of 3D-printed PEKK along with criteria for process optimization in order to customize its properties to meet specific application requirements. This research not only advances the knowledge of PEKK as a 3D-printing material but also provides insights into the multifaceted nature of multiscale material characterization.

Subsidence of a partially porous titanium lumbar cage produced by electron beam melting technology

The lumbar intervertebral devices are widely used in the surgical treatment of lumbar diseases. The subsidence represents a serious clinical issue during the healing process, mainly when the interfaces between the implant and the vertebral bodies are not well designed. The aim of this study is the evaluation of subsidence risk for two different devices. The devices have the same shape, but one of them includes a filling micro lattice structure. The effect of the micro lattice structure on the subsidence behavior of the implant was evaluated by means of both experimental tests and finite element analyses. Compressive tests were carried out by using blocks made of grade 15 polyurethane, which simulate the vertebral bone. Non-linear, quasi-static finite element analyses were performed to simulate experimental and physiologic conditions. The experimental tests and the FE analyses showed that the subsidence risk is higher for the device without micro lattice structure, due to the smaller contact surface. Moreover, an overload in the central zone of the contact surface was detected in the same device and it could cause the implant failure. Thus, the micro lattice structure allows a homogenous pressure distribution at the implant-bone interface.

Subject-specific finite element analysis of a lumbar cage produced by electron beam melting

The aim of this study was the analysis of the mechanical behaviour of a partially porous lumbar custom-made cage by means of a subject-specific finite element analysis (FEA). The cage, made of Ti6Al4V ELI alloy, was produced via electron beam melting (EBM) process and surgically implanted in a female subject, 50 years old. The novelty of this study was the customized design of the cage and of its internal structure, which is impossible to obtain with the traditional production techniques. The 3D model of the spine was obtained from the computed tomography (CT) of the patient. Moreover, high-resolution industrial CT was also used to reconstruct a 3D model of the cage, with its real (as-produced) features, such as superficial roughness, morphology of the bulk and of the porous structure. The workflow was divided in several steps: the main finite element analyses were non-linear and quasi-static regarding: the rhombic dodecahedron (RD) unit cell of the porous structure; the device; the whole L4-L5 motion segment with the implanted cage. Stress distribution was calculated under compression load for all models. For the RD unit cell, the maximum stress appeared at the connected cross nodes, where notch effect was present. For the cage subjected to a load of 1 kN, the porous structure did not present any functional failure. For the whole biomechanical system subjected to a physiological load of 360 N, the calculated stress in the bone was smaller than its yield strength value. On the axial view, a zone with higher compressive stresses was present on the L5 vertebral body. This was due to the contact stress between the cage and the vertebra. From the comparison between FE results and the CT images of the spine, bone remodelling was supposed, with the formation of new bone. Graphical abstract Workflow showing the phases of the research.

[Laboratory parameters as a guide for the radiologic study of infections of the urinary tract in childhood]

Forty-nine children with urinary tract infection aged between 15 days and 10 years were studied. Thirty-three of them (67.3%) had urinary tract malformations. We valued the following parameters: a) White Blood Cells; b) Leukocyte differential; c) ESR at the first hour; d) CRP; e) Concentration ability; f) Body temperature. We wanted to investigate the usefulness of these parameters to predict which patients should be studied by X-ray of urinary tract. Single parameters did not prove very sensitive; the highest correlations were found with ESR and CRP, which were positive in 76% of the cases of malformations. Furthermore we valued the sensitivity and specificity of the tests grouped together: the highest values of sensitivity (97%) and specificity (31%) were obtained coupling the ESR and concentration ability.

[Vascular changes in postmastectomy "thick arm"]

The authors, after shortly outlining some pathogenetic theories about postmastectomy "big arm", especially dwell upon the theory of the hindered venous discharge. They, subsequently, through a clear and interesting phlebographic iconography, illustrate ten of the 41 cases suffering from such syndrome, they recently had the opportunity to observe. On the basis of their own experience, and according to part of the literature thereabout, the authors think very probably the postmastectomy "big arm" is to be ascribed to the hindered venous reflux of upper limb (for thrombosis or compression), due to the operation of mastectomy. As a conclusion, they suggest the improvement or recovery of this syndrome by stepping over the stenosed venous tract through a by-pass.