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Biomimetic medical devices

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The presentation gives overview of the biomimetics medical devices.These devices have a potential to overcome drawbacks of traditional medical devices. Intensive research is going on biomimicking natural process in designing the devices in order to get effective treatment of patient, or discovering novel devices.

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Biomimetic medical devices

  1. 1. Biomimetic medical devices and materials By- Abhishek R Indurkar 17PBT202 Institute of Chemical Technology Mumbai
  2. 2. In 1957, Otto Schmitt coined the term “Biomimetics” which means, ‘The study of formation, structure or function of biologically produced substances, materials, biological mechanisms and processes especially for the purpose of synthesising similar products by artificial mechanisms which mimic natural ones’. One of the finest example of biomimicry was set by Leonardo da Vinci by making numerous sketches and notes of ‘flying machine’. Velcro is an another example of a biomimetic invention made by Swiss engineer George de Mestral.
  3. 3. Fig 1. Burr fruit and velcro
  4. 4. The natural shapes are highly aesthetic. The design of objects found in nature is the result of prolonged optimisation processes. There is nothing haphazard about the shape of an edge or structure each single one has been designed with a specific function in mind. In the similar way the bionically inspired surgical instruments, prostheses and orthoses have a crucial role in Medical Engineering to overcome the drawbacks of traditional equipment.
  5. 5. Biomimetic medical devices are designed to imitate the function of the original organ or a tissue which give patient ease in the recovery.
  6. 6. Biomimetic Hand Exotendon Device or BiomHED, which is based on a bio-inspired design, in order to achieve effective hand rehabilitation after stroke. The device is designed to generate functional movements by actuating ‘exotendons’ that replicate the anatomical structure of the major extrinsic and intrinsic muscle-tendons of the hand. Accordingly, each exotendon assumes the kinetic function of the corresponding muscle-tendon, and the independent and synergistic actuation of the exotendons will enable functional use of the hand by generating the coordination patterns of the finger joints specific to manual tasks.
  7. 7. Function of finger muscle-tendons The index finger is comprised of three joints: metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints. Motion about the joints is controlled by seven muscle-tendons, including extensor digitorum communis (EDC), extensor indicis proprius (EIP), flexor digitorum superficialis(FDS), flexor digitorum profundus (FDP), first dorsal interosseous (FDI), first palmar interosseous (FPI), and lumbricalis (LUM). They had mimic the function of the following muscle-tendons: EDC, FDP, FDI/LUM, and FPI, as their functional importance during finger movements and fingertip force generation in grip tasks.
  8. 8. The BIOMHED employs four ‘exotendons’ for each finger, which approximately replicate the function of five major muscle- tendons: EDC, FDP, FDI/LUM, FPI. The exotendons are connected to the servo motors that provide appropriate tensions, and the motors are located on the forearm in order to avoid adding additional bulky structure to the hand. The four cables, i.e., exotendons, assume similar paths with five major muscle-tendons of the finger 1) The first cable (ET1) runs on the dorsal side of each finger and creates concurrent extension of all three joints 2) The second (ET2) runs on the palmar side of each finger, thereby creating concurrent flexion of all joints. 3) The third and fourth cables (ET3/4) originate from the dorsal aspect of the DIP joint and run laterally, i.e., ET3 on the radial side and ET4 on the ulnar side
  9. 9. Stroke is a leading cause of serious, long-term disability in the world. While many stroke victims eventually regain use of their lower extremities, upper limb recovery is slow and often limited. The functional impairment of the hand and upper extremity can significantly degrade the quality of life of those affected. A number of assistive devices have recently been developed in an attempt to restore hand functions for the neurologically impaired patients. However, the complexity of the motions achieved by these systems is generally limited thereby resulting in a fixed inter joint coordination pattern.
  10. 10. It is a device used for incorporating sensing, control, and actuation for use in treating ankle foot pathologies associated with neuromuscular disorders. The design mimics the muscle tendon ligament skin architecture in the biological musculoskeletal system of the human ankle.
  11. 11. The prototype is composed of three physical layers: base, actuation, and sensing. The control hardware connects the actuation and sensing layers to enable the execution of complex control rules. The entire prototype, including electronics and batteries but not including the mass of the air source, weighs approximately 950 g.
  12. 12. Ankle–foot pathologies in patients with neuromuscular disorders, caused by cerebral palsy (CP), amyotrophic lateral sclerosis, multiple sclerosis, or stoke, can result in abnormal gaits over time, such as drop foot and crouch gait. There have been various approaches for treating ankle– foot pathologies. One of the most typical solutions is to wear rigid ankle braces, such ankle foot orthoses (AFOs). These devices improve gait abnormalities by forcing the ankle joint angle to be close to 90◦ . However, long-term use of these passive devices causes disuse atrophy of muscles and consequently makes the user physically dependent on the device
  13. 13. Biomimetics is a science that uses natural designs or mechanisms to solve human problems. Accordingly, in a manner similar to orthodontic correction, the judicious use of the vectors induced in oral appliance therapy might provide an alternative protocol for the resolution of obstructive sleep apnea OSA, with the upper airway being the target in mild to moderate cases. OSA can be resolved in adults using a novel protocol that utilises biomimetic oral appliance therapy (BOAT)
  14. 14. The BioFriend™ BioMask™ facemasks are identically comprised of four layers of standard filtration materials used in currently approved surgical face-masks and respirators. a. An outer layer of spun-bond polypropylene. b. A second layer of polyester. c. A third layer of melt-blown polypropylene. d. An inner (fourth) layer of spun bound polypropylene.
  15. 15. The first and second individual layers of the facemasks have been treated with two different anti-microbial compounds that independently inactivate pathogens - the outer active layer with a low-pH hydrophilic plastic coating, and the second active layer with copper/zinc ions. The outer active layer of the BioFriend™ BioMask™ surgical facemask rapidly inactivates viruses through exposure to the low pH environment. This induces structural rearrangement of lipids and other structures, resulting in spontaneous virus denaturation. The inner active layer, treated with positively charged copper/zinc ions, binds pathogens by binding negatively charged groups e.g., sulfhydryl and carboxyl groups, which are present on all viruses, bacteria and fungi. This activity is known as Ionic Mimicry. These metal ions exert a toxic effect upon pathogens, known as the Oligodynamic Effect
  16. 16. Biofilm is a biologically glycocalyx like antiadhesive coatings which is used to inhibit Staphylococcus aureus and Pseudomonas aeruginosa colonization on commercial totally implantable venous access ports (TIVAPs). Catheters improve patients’ healthcare but, the hydrophobic nature of their surface material promotes protein adsorption and cell adhesion. Catheters are therefore prone to complications, such as colonisation by bacterial and fungal biofilms, which causes infections. There is currently, no fully efficient method for treating catheter related biofilms besides traumatic and costly removal of colonised devices.
  17. 17. The external layer of a cell membrane, known as the glycocalyx, is composed of polysaccharides and prevents undesirable protein adsorption and nonspecific cell adhesion. Thus, mimicking the nonadhesive properties of a glycocalyx may provide a solution to the clinical problem associated with device colonisation. In this context, regarding the advantage of optimising the polysaccharide structure, the preparation of glycocalyx like hydrophilic methyl-cellulose (MeCe) polymer nanofilms grafted onto polydimethylsiloxane.
  18. 18. Each year over 6 lakh people lose there lives due to colon cancer in the world. Even though the colonoscopy examination procedures are applied, there is a certain amount of miss rate in colonoscopy procedures due to narrow field of view (FOV) imagery employed in current systems. Since the human colon has a folded structure, while the colonoscope moves toward the colon, it misses the behind- fold regions at the peripheral areas with respect to the forward and backward movement of the colonoscope.
  19. 19. The insect eye mimicking approach, named as Panoptic is taken as constructing a hemispherical multi-camera system with many lenses and sensors placed on a hemispherical frame similar to the insects’ natural lens-sensor designs.
  20. 20. The pacemaker is an electronic biomedical device that can regulate the human heart beat when its natural regulating mechanism breaks down. It is a small box implanted in the chest cavity and has electrodes that are in direct contact with heart. First developed in 1950s, the pacemaker has undergone various design changes and has found new applications since its invention. Today pacemakers are widely used, implanted in ten of thousand patients annually.
  21. 21. Hearing restoration have a great impact on the psychological well being, quality of life and economic independence for people with hearing impairments. In cases of mild hearing impairment, it is possible to restore hearing through a hearing aid. But, damage to the hair cells in the cochlea leads to sensorineural hearing loss (SNHL), which results in serve hearing impairment with loss of more than 90dB. CL is a surgically implanted electronic device which stimulates the auditory nerve, bypassing the damaged hair cells in the cochlea. Although CI are used as a clinical solutions to restore hearing in patients with SNHL, it has a number of drawbacks. The extracorporeal unit can be inconvenient in daily life, in taking a shower, participating in water sports, and sleeping. It is also associated with aesthetic concerns and the social stigma of hearing impairment.
  22. 22. Artificial basilar membranes (ABMs) are an attractive option to overcome the limitations of conventional CIs. The ABM is an acoustic transducer that mimics cochlear tonotopy. For mimicking the ABMs, mechanical frequency selectivity is achieved by varying the structural parameters such as the width of the membrane, beam length and beam thickness. In addition, acoustic-to-electrical energy conversion is realised via piezoelectric effect
  23. 23. The authors aimed to insert the flexible ABM into the cochlea and use it to detect vibration of the BM by generating piezoelectric output from the PZT film. In the simulation, the flexible PZT thin film can generate sufficient electrical output (3 V) to stimulate the auditory nerve when mechanical displacement of the BM is about 600 nm under sound pressure. The flexible iPANS was then fabricated on a film. The fabricated iPANS was attached to the flexible trapezoidal silicone membrane (SM) for mechanical frequency selectivity.
  24. 24. A biomaterial is regarded as any nondrug material that can be used to treat, enhance or replace any tissue, organ, or function in an organism. Any material natural or man made can be a biomaterial as long as it serves the stated medical and surgical purposes. An ideal biomaterial is one that is non-immunogenic, biocompatible, and biodegradable, which can be functionalised with bioactive proteins and chemicals.
  25. 25. Material Applications Reference Polymers Tissue engineering scaffolds for skin cartilage, liver etc (Eaglstein, Falanga et. al 1998) Metals and alloy Bone Implants ( M Saini 2015) Composites Arteries (Wang et al. 2015) Ceramics Tissue engineering scaffolds (Leong, Cheah et al. 2003) Hydrogel Tissue engineering of bladder (Sivaraman 2015)
  26. 26. Thank you
  27. 27. 1.Chong L, Zarith N and Sultana N “Poly(Caprolactone)/chitosan-based scaffold using freeze drying technique for bone tissue engineering application.” Conference: 2015 10th Asian Control Conference (ASCC) May 2015. 2.Endogan Tanir, T., Hasirci, V. and Hasirci, N. “Preparation and characterization of Chitosan and PLGA-based scaffolds for tissue engineering applications.” Polymer Composites 36 (2015): 1917–1930. 3.Fauzi MB, Chowdhury SR, Aminuddin BS and Ruszymah BHI “Fabrication of collagen type I scaffold for skin tissue engineering.” Regenerative Research 3.2 (2014) 60-61. 4.Guiping Ma, Zhiliang Wang, et al. “Freeze-dried chitosan–sodium hyaluronate polyelectrolyte complex fibers as tissue engineering scaffolds.” New Journal of Chemistry 38 (2014): 1211-1217. 5.Haugh MG, Murphy CM and O'Brien FJ “Novel freeze-drying methods to produce a range of collagen-glycosaminoglycan scaffolds with tailored mean pore sizes.” Tissue Engineering Part C Methods 16.5 october (2010) :887-94. 6.Held M, Rahmanian-Schwarz A, et al. “A Novel Collagen-Gelatin Scaffold for the Treatment of Deep Dermal Wounds-An Evaluation in a Minipig Model.” Dermatol Surg 42.6 (2016):751-6. 7.Liu,J, Lu F, et al. “Healing of skin wounds using a new cocoon scaffold loaded with platelet-rich or platelet-poor plasma.” RSC Advances 7 (2017): 6474-6485. 8.Leong, K,. et al. “Solid freedom fabrication of three demential scaffold for engineering replacement and tissue organs”. Biomaterials (2003) 24:(13): 2363:2378. 9.Lowe CJ, Reucroft IM, Grota MC and Shreiber DI “Production of Highly Aligned Collagen Scaffolds by Freeze-drying of Self- assembled, Fibrillar Collagen Gels.” ACS Biomaterials Science
  28. 28. 9.Lowe CJ, Reucroft IM, Grota MC and Shreiber DI “Production of Highly Aligned Collagen Scaffolds by Freeze-drying of Self- assembled, Fibrillar Collagen Gels.” ACS Biomaterials Science & Engineering 2.4 April (2016): 643-651. 10.Ma L, Gao C, et al. “Collagen/chitosan porous scaffolds with improved biostability for skin tissue engineering.” Biomaterials 24.26 November (2003): 4833-41. 11.Mahboudi S, Pezeshki-Modaress & Noghabi “The Study of Fibroblast Cell Growth on the Porous Scaffold of Gelatin–Starch Blend Using the Salt-Leaching and Lyophilization Method.” International Journal of Polymeric Materials and Polymeric Biomaterials 64.12 (2015). 12.O'Brien FJ, “Biomaterials and scaffold for tissue engineering” Material today (2011) 14(3): 88-95. 13.O'Brien FJ, Harley BA, Yannas IV, Gibson L “Influence of freezing rate on pore structure in freeze-dried collagen-GAG scaffolds.” Biomaterials 25.6 March (2004):1077-86. 14.Vishwanath V, Pramanik K and Biswas A “Optimization and evaluation of silk fibroin-chitosan freeze-dried porous scaffolds for cartilage tissue engineering application.” Journal of Biomaterial Science, Polymer Edition 27.7 (2016):657-74. 15.Waghmare V, Wadke P, “Starch based nanofibrous scaffolds for wound healing applications.” Bioactive Materials (2017):1-12. 16.Wang H-M, Chou Y-T, et al. “Novel Biodegradable Porous Scaffold Applied to Skin Regeneration.” PLoS One 8.6 June (2013): e56330. 17.Wang S, Goecke T, et al. “Freeze-dried heart valve scaffolds.” Tissue Engineering Part C Methods18.7 July (2012): 517-25. 18. Eaglstein W.H and Falanga V, “Tissue engineering and the development of Apligraf a human skin equivalent,” Advances in Wound Care, vol. 11, supplement 4, pp. 1–8, 1998. 19.You C, Li Q, et al. “Silver nanoparticle loaded collagen/chitosan scaffolds promote wound healing via regulating fibroblast migration and macrophage activation.” Scientific reports 7.1 September (2017): 10489.
  29. 29. Thank you
  30. 30. “Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea” By- Abhishek R Indurkar 17PBT202 Under guidance of PROF. G.D.YADAV
  31. 31. Obstructive sleep apnea (OSA) is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. This type of apnea occurs when the throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring.
  32. 32. For the management of obstructive sleep apnea (OSA) in adults, some healthcare professionals prefer to prescribe continuous positive airway pressure (CPAP) masks while others prefer mandibular advancement devices (MADs). The drawbacks of these are discomfort, dry mouth, excessive salivation and ill-fitting appliances. CPAP MAD
  33. 33. Biomimetics is a science that uses natural designs or mechanisms to solve human problems. Accordingly, in a manner similar to orthodontic correction, the judicious use of the vectors induced in oral appliance therapy might provide an alternative protocol for the resolution of obstructive sleep apnea OSA, with the upper airway being the target in mild to moderate cases. OSA can be resolved in adults using a novel protocol that utilises biomimetic oral appliance therapy (BOAT)
  34. 34. 10 consecutive patients were recruited for this study. OSA following an overnight sleep study that had been interpreted by a sleep physician. The exclusion criteria included: age <21yrs.; lack of oral appliance compliance; active periodontal disease; tooth loss during treatment; poor oral hygiene.
  35. 35. After careful history-taking and craniofacial examination, a bite registration was obtained in the upright-sitting position with corrected jaw posture in the vertical axis specific for each subject. Upper and lower polyvinyl siloxane impressions were also obtained. Following a diagnosis of mild to moderate OSA, a biomimetic, upper DNA appliance® was prescribed to each subject. The BOAT needed to be professionally-adjusted approximately every 4 weeks, and all subjects reported for review each month. Every 3 months, the overnight sleep studies were repeated.
  36. 36. The mean AHI fell by 65.9% to 4.5 ± 3.6. after BOAT with no appliances in the mouth during sleep when the post-treatment sleep study was undertaken, indicating enhanced upper airway function.
  37. 37. Improvements in sleep quality in the absence of CPAP or MADs in patients diagnosed with OSA have never been reported in the literature. Therefore, the preliminary results obtained might represent an alternative to CPAP and MADs for the resolution of OSA. The device is patient friendly, which overcome the drawbacks of CPAP and MAD.
  38. 38. Critical analysis of paper
  39. 39. Title of paper: “Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea” Indicate clearly about what they done
  40. 40. Summaries purpose of research, the principle, results and major conclusions. Gives a complete overview of work. Provide overall result obtained
  41. 41. Paper is technically correct. The assumption made by author are logical and proven. There is no unnecessary repetition of matter and basic is very well illustrated. Therefore, the paper is easy to follow and understand.
  42. 42. References cited in the paper are complete and as per guidance. References mentioned here are helpful to understand the work. All the references are genuine. The references cited are adequate and support the facts and observations.
  43. 43. The AHI of the patient H has increased after the treatment. The reason behind this is not explained by the author. Author has mentioned that the therapy can be efficiently used in children but didn’t give any specification regarding this.
  44. 44. 1. Mayo clinic staff. (2017 August 02). Obstructive sleep apnea. Retrieved from https://www.mayoclinic.org/diseases- conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 on 23/01/18 2. Donovan J. (2015). How to Sleep Easier With Your CPAP Machine. Retrieved from https://www.webmd.com/sleep-disorders/sleep- apnea/features/cpap-machine#1 23/01/18 3. Mandibular Advancement Devices – MAD’s. (2017). Retrieved from https://www.sleepassociation.org/mandibular-advancement- device/ 23/01/18 4.Singh GD, Griffin TM and Chandrashekhar R. “Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea”. Austin J Sleep Disord. 2014;1(1): 5 Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije M. Long- term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration. 2011; 82: 162-168. 6 Doff MH, Finnema KJ, Hoekema A, Wijkstra PJ, de Bont LG, Stegenga B. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig. 2013; 17: 475-482. 7. De Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, et al. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005; 1: 143-152. 8. Gindre L, Gagnadoux F, Meslier N, Gustin JM, Racineux JL. Mandibular advancement for obstructive sleep apnea: dose effect on apnea, long-term use and tolerance. Respiration. 2008; 76: 386-392. 9 Chen H, Lowe AA, de Almeida FR, Fleetham JA, Wang B. Three-dimensional computer-assisted study model analysis of long-term oral- appliance wear. Part 2. Side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod Dentofacial Orthop. 2008; 134: 408-417. 10 Gong X, Zhang J, Zhao Y, Gao X. Long-term therapeutic ef cacy of oral appliances in treatment of obstructive sleep apnea-hypopnea syndrome. Angle Orthod. 2013; 83: 653-658. 11 Tsuda H, Almeida FR, Masumi S, Lowe AA. Side effects of boil and bite type oral appliance therapy in sleep apnea patients. Sleep Breath. 2010; 14: 227-232.
  45. 45. THANK YOU

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