Lower Von Research Articles

Static analysis of wind blades based on weight loads to the gravitation and the centrifugal forces Using Finite Element

Static analysis of wind turbine blades that convert kinetic energy using wind to electrical power has been analyzed using Ansys model. The geometry was imported in ANSYS workbench 2020R1, where the material was changed to Epoxy E-Glass Wet. The mesh independence that occurred at 800 and 600 element sizes and an element size of 800 was chosen for subsequent static analysis. The static analysis shows that the total deformation and von Mises stress of the wind turbine blade was improved at both the vertical position and the horizontal position by 40.0% and 38.61%, respectively. Besides, the static analysis showed an almost linear mode shape increased from mode lines. Nevertheless, Campbell's diagram showed that resonance vibration occurred at an amplitude of 5.5x106Pa with a corresponding frequency of 5Hz, which gave a rotational speed of 262.4x106 rpm. This shows that the impulse force is better applied in wind turbine blade transient analysis at a lower von Mises stress to attain a quicker damping response steady-state, which favors wind turbine blade analysis. Overall, the wind turbine blade is better designed at a vertical position to allow better deformation stress at a static position. Conversely, the von Mises stress showed 44.64% and 38.61% at horizontal and vertical positions. This also agrees with static total deformation, since stress is better managed at a lower percentage range.

Design and Optimization of LPG Safety Cap using Finite Element Method

This paper presents a comprehensive study on the design and optimization of LPG safety caps, aimed at enhancing safety, reducing material consumption, and optimizing performance. The project employs SolidWorks simulation tools to conduct research and concept design phases. The primary objective is to ensure product safety while minimizing costs through Finite Element Analysis (FEA). The final product undergoes rigorous evaluation for performance and consumer safety. Three main goals guide this investigation: to scrutinize existing LPG safety cap designs, minimize material usage, and simulate the optimal design for enhanced safety. Analysis of the current design reveals vulnerabilities, including theft of LPG gas from sealed cylinders and escalating HDPE prices. Proposed designs simplify the current model and economize material consumption, successfully addressing the second objective. Through simulation, an optimal design (Design 8) emerges with superior characteristics compared to the existing model. Design 8 demonstrates a reduced total weight, higher safety factor, and lower maximum von Mises stress value. Notably, it exhibits enhanced safety and resilience, mitigating failure risks under stress conditions. The findings highlight the potential for creating stronger and safer designs while minimizing material requirements. In conclusion, Design 8 emerges as a superior alternative to the current design, boasting advantages in weight reduction, stress tolerance, safety factor, and optimization potential. This study underscores the significance of utilizing advanced computational methods to refine engineering designs for improved safety and efficiency in LPG safety caps.

Assessment of different treatment alternatives for patients with total maxillectomy.

To assess the biomechanical advantages of combining zygoma and partial subperiosteal implants for maxillary reconstruction in severely atrophic maxillae, offering potential solutions to the challenges posed by traditional reconstruction methods. A finite element analysis used a craniofacial model simulating a totally resected maxilla. Four treatment scenarios (SCs) were evaluated: SC-1, the quad zygoma approach; SC-2, two zygoma implants (ZIs) and a one-piece subperiosteal implant (SI); SC-3, two ZI and a two-piece SI; and SC-4, four ZI and a one-piece SI. Stress distributions on bone, implants, abutments, and metal frameworks were compared under occlusal forces. For the simulated bone regions under vertical and oblique forces, SC-4 values were higher than SC-1, while SC-2 and SC-3 values were comparable for pmax and pmin. In addition, SC-2 and SC-3 values were lower than those of SC-1 and SC-4. The most balanced von Mises stress values on the ZIsand were observed in SC-3 under vertical and oblique forces. Furthermore, lower von Mises stress values on the abutments were seen in SC-3 under oblique and vertical forces. Although the lower von Mises stress values on the metal frameworks at the lateral incisor and first premolar side were seen in SC-3, lower von Mises values were observed in SC-4 in the first molar region. Overall, this study suggests that combining zygoma and partial subperiosteal implants may be a promising approach for reconstructing severely atrophic maxillae. These implants may offer improved biomechanical properties compared to ZIs alone.

Finite element analysis of non-ultraviolet and ultraviolet-irradiated titanium implants.

The purpose of this study is to calculate von Mises stresses, von Mises strains, deformation, principal stresses and principal elastic strains of non-UV and UV-irradiated hybrid SLA (sandblasted, large-grit, acid-etched)-coated titanium implants. A cross-sectional analytical study was conducted at the Institute of Dentistry, CMH Lahore Medical College. Cone beam computed tomography (CBCT) data of One Hundred and Thirty Eight Dio Hybrid sandblasted and acid-etched implants of identical dimensions (10mm in length and 4.5mm in diameter) were allocated in the three groups. Control group A samples were not given UV irradiation, while groups B and C were given UVA (382nm, 25 mWcm-2) and UVC (260nm, 15 mWcm-2) irradiation, respectively. The CBCT data were analyzed using FEA (ANSYS software). CBCT images were taken before functional loading (8thweek) and after functional loading (26thweek). A 3-way ANOVA test was employed to see the difference between the three groups. Tukey test was utilized for multiple comparisons. p ≤ 0.05 was considered significant. The control group exhibited the highest average values for maximum von Mises stress, von Mises strain, deformation, principal stress, and principal elastic strain in both the maxilla and mandible compared to the UV-irradiated groups. Additionally, these measures consistently displayed higher averages in the maxilla across all groups compared to the mandible. Particularly, the UVC-irradiated group demonstrated the lowest von Mises stresses around the implants compared to the UVA group. Insignificant differences were observed between UVA- and UVC-irradiated implants in terms of principal stress, deformation, von Mises strain, and principal elastic strain. The only notable distinction was in von Mises stress, where the UVC-irradiated group exhibited lower von Mises stress around SLA-coated titanium implants.

Bispherical metal augment improved biomechanical stability in severe acetabular deficiency reconstruction: a comparative finite element analysis

BackgroundThis study used finite element analysis (FEA) to compare the biomechanical stability of bispherical metal augment (BA) and wedge-shaped trabecular-metal augment (TA) in different acetabular defect reconstruction models, thereby explaining the application value of this novel bispherical augment in complex hip revision.MethodsThree different acetabular defect pelvis models originating from three representative patients with different types of severe acetabular defects (Paprosky IIC, IIIA, and IIIB) were constructed and reconstruction with BA and TA technique was simulated. Based on the FEA models, the displacement of reconstruction implants, relative displacement of bone implants, and hemi-pelvic von Mises stress were investigated under static loads.ResultsBA acquired smaller reconstruction system displacement, less relative displacement of bone implants, and lower pelvic von Mises stress than TA in all Paprosky IIC, IIIA, and IIIB defect reconstructions.ConclusionThe FEA results show that BA could acquire favourable biomechanical stability in severe acetabular defect reconstruction. This technique is a reliable method in complex hip revision.

Finite element analysis and surrogate-optimized design of a nature-inspired auxetic stent

Prior studies have revealed that the structural design of stents is critical to reducing some of the alarming post-operative complications associated with stent-related intervention. However, the technical search for stents that guarantee robustness against stent-induced post-intervention complications remains an open problem. Along this objective, this study investigates a re-entrant auxetic stent's structural response and performance optimizations. In pursuit of the goal, a nonlinear finite element analysis (FEA) is employed to uncover metrics characterizing the auxetic stent’s mechanical behavior. Subsequently, the non-dominated sorting genetic algorithm (NSGA-II) is implemented to simultaneously minimize the stent’s von Mises stress and the elastic radial recoil (ERR). Results from the FEA revealed a tight connection between the stent’s response and the features of the base auxetic building block (the rib length, strut width, and the re-entrant angle). It is observed that the auxetic stent exhibits a much lower ERR. Besides, larger values of its rib length and re-entrant angle are noticed to favor smaller von Mises stress. The Pareto-optimal front from the NSGA-II-based optimization scheme revealed a sharp trade-off in the simultaneous minimization of the von Mises stress and the ERR. Moreover, an optimal combination of the auxetic unit cell’s geometric parameters is found to yield a much lower maximum von Mises stress of ≈ 403 MPa and ERR of ≈ 0.4 % .

Breakdown up to 12 Kv in NiO/β-Ga2O3 Vertical Heterojunction Rectifiers

Vertical heterojunction NiO/β n-Ga2O/n+ Ga2O3 rectifiers fabricated on 15 µm thick drift layers with carrier concentration 8.8 x1015 cm-3 and employing simple dual-layer PECVD SiNx/SiO2 edge termination demonstrate breakdown voltages (VB) up to 12 kV, on-voltage (VON) of ~2.2V and on-state resistance RON of 11.1-12 mΩ.cm2 . The breakdown field is ~8 MV. cm-1, close to the commonly accepted theoretical value. The associated power figure-of-merit, VB 2/RON is 13 GW·cm-2 . By sharp contrast, Schottky rectifiers concurrently fabricated on the same drift layers had maximum VB of 2.9 kV, but lower VON of 0.71-0.75 V. Transmission electron microscopy showed an absence of lattice damage between the PECVD and sputtered films within the device and the underlying epitaxial Ga2O3. The key advances are thicker, lower doped drift layers and optimization of edge termination design and deposition processes. Figure 1

Finite Element Analysis Comparing the Biomechanical Parameters in Multilevel Posterior Cervical Instrumentation Model Involving Lateral Mass Screw versus Transpedicular Screw Fixation at the C7 Vertebra.

Basic research. This finite element (FE) analysis (FEA) aimed to compare the biomechanical parameters in multilevel posterior cervical fixation with the C7 vertebra instrumented by two techniques: lateral mass screw (LMS) vs. transpedicular screw (TPS). Very few studies have compared the biomechanics of different multilevel posterior cervical fixation constructs. Four FE models of multilevel posterior cervical fixation were created and tested by FEA in various permutations and combinations. Generic differences in fixation were determined, and the following parameters were assessed: (1) maximum moment at failure, (2) maximum angulation at failure, (3) maximum stress at failure, (4) point of failure, (5) intervertebral disc stress, and (6) influence of adding a C2 pars screw to the multilevel construct. The maximum moment at failure was higher in the LMS fixation group than in the TPS group. The maximum angulation in flexion allowed by LMS was higher than that by TPS. The maximum strain at failure was higher in the LMS group than in the TPS group. The maximum stress endured before failure was higher in the TPS group than in the LMS group. Intervertebral stress levels at C6-C7 and C7-T1 intervertebral discs were higher in the LMS group than in the TPS group. For both models where C2 fixation was performed, lower von Mises stress was recorded at the C2-C3 intervertebral disc level. Ending a multilevel posterior cervical fixation construct with TPS fixation rather than LMS fixation at the C7 vertebra provides a stiff and more constrained construct system, with higher stress endurance to compressive force. The constraint and durability of the construct can be further enhanced by adding a C2 pars screw in the fixation system.

Recombinant human thrombopoietin in alleviating endothelial cell injury in sepsis

BackgroundTo evaluate the effect of recombinant human thrombopoietin (rhTPO) on clinical prognosis by exploring changes in endothelial cell injury markers and inflammatory factors in patients with sepsis after treatment with rhTPO. MethodsThis retrospective observational study involved patients with sepsis (diagnosed according to Sepsis 3.0) admitted to Shanghai General Hospital intensive care unit from January 1, 2019 to December 31, 2022. Patients were divided into two groups (control and rhTPO) according to whether they received rhTPO. Baseline information, clinical data, prognosis, and survival status of the patients, as well as inflammatory factors and immune function indicators were collected. The main monitoring indicators were endothelial cell-specific molecule (ESM-1), human heparin-binding protein (HBP), and CD31; secondary monitoring indicators were interleukin (IL)-6, tumor necrosis factor (TNF)-α, extravascular lung water index, platelet, antithrombin III, fibrinogen, and international normalized ratio. We used intraperitoneal injection of lipopolysaccharide (LPS) to establish a mouse model of sepsis. Mice were randomly divided into four groups: normal saline, LPS, LPS + rhTPO, and LPS + rhTPO + LY294002. Plasma indicators in mice were measured by enzyme-linked immunosorbent assay. ResultsA total of 84 patients were included in the study. After 7 days of treatment, ESM-1 decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=38.6 [interquartile range, IQR: 7.2 to 67.8] pg/mL vs. median=23.0 [IQR: −15.7 to 51.5] pg/mL, P=0.008). HBP and CD31 also decreased significantly in the rhTPO group compared with the control group (median=59.6 [IQR: −1.9 to 91.9] pg/mL vs. median=2.4 [IQR: −23.2 to 43.2] pg/mL; median=2.4 [IQR: 0.4 to 3.5] pg/mL vs. median=−0.6 [IQR: −2.2 to 0.8] pg/mL, P <0.001). Inflammatory markers IL-6 and TNF-α decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=46.0 [IQR: 15.8 to 99.1] pg/mL vs. median=31.2 [IQR: 19.7 to 171.0] pg/mL, P <0.001; median=17.2 [IQR: 6.4 to 23.2] pg/mL vs. median=0.0 [IQR: 0.0 to 13.8] pg/mL, P=0.010). LPS + rhTPO-treated mice showed significantly lower vascular von Willebrand factor (P=0.003), vascular endothelial growth factor (P=0.002), IL-6 (P <0.001), and TNF-α (P <0.001) than mice in the LPS group. Endothelial cell damage factors vascular von Willebrand factor (P=0.012), vascular endothelial growth factor (P=0.001), IL-6 (P <0.001), and TNF-α (P=0.001) were significantly elevated by inhibiting the PI3K/Akt pathway. ConclusionrhTPO alleviates endothelial injury and inflammatory indices in sepsis, and may regulate septic endothelial cell injury through the PI3K/Akt pathway.

Breakdown up to 13.5 kV in NiO/β-Ga2O3 Vertical Heterojunction Rectifiers

Vertical heterojunction NiO/β n-Ga2O/n+ Ga2O3 rectifiers with 100 μm diameter fabricated on ∼17–18 μm thick drift layers with carrier concentration 8.8 × 1015 cm−3 and employing simple dual-layer PECVD SiNx/SiO2 edge termination demonstrate breakdown voltages (VB) up to 13.5 kV, on-voltage (VON) of ∼2.2 V and on-state resistance RON of 11.1–12 mΩ.cm2. Without edge termination, the maximum VB was 7.9 kV. The average critical breakdown field in heterojunctions was ∼7.4–9.4 MV. cm−1, within the reported theoretical value range from 8–15 MV.cm−1 for β-Ga2O3. For large area (1 mm diameter) heterojunction deives, the maximum VB was 7.2 kV with optimized edge termination and 3.9 kV without edge termination. The associated maximum power figure-of-merit, VB 2/RON is 15.2 GW·cm−2 for small area devices and 0.65 GW.cm−2 for large area devices. By sharp contrast, small area Schottky rectifiers concurrently fabricated on the same drift layers had maximum VB of 3.6 kV with edge termination and 2.7 kV without edge termination, but lower VON of 0.71–0.75 V. The average critical breakdown field in these devices was in the range 1.9–2.7 MV. cm−1, showing the importance of both the heterojunction and edge termination. Transmission electron microscopy showed an absence of lattice damage between the PECVD and sputtered films within the device and the underlying epitaxial Ga2O3. The key advances are thicker, lower doped drift layers and optimization of edge termination design and deposition processes.

Investigating the Influence of All-Ceramic Prosthetic Materials on Implants and Their Effect on the Surrounding Bone: A Finite Element Analysis

This study aims to assess and compare the impact of Monolithic Zirconia (MZ) and In-Ceram Zirconia (ZP) superstructures on stress distribution within implants and D2/D4 bone densities under 200 N vertical and oblique occlusal loads using three-dimensional finite element analysis via ANSYS WORKBENCH R2. The analysis employed maximum and minimum von Mises stress values. Modeling an implant (4.2 mm diameter, 10 mm length) and abutment (0.47 mm diameter), with an 8 mm diameter and 6 mm length single crown, the research identified lower von Mises stresses in D2 cancellous bone with the MZ model under vertical loading. Conversely, under oblique loading, the ZP model exhibited maximum von Mises stresses in D4 bone around the implant. This underscores the critical need to consider physical and mechanical properties, beyond mere aesthetics, for sustained implant success. The findings highlight the effect of material composition and stress distribution, emphasizing the necessity of durable and effective implant treatments.

In silico comparative biomechanical analysis of oblique and chevron medial displacement calcaneal osteotomies for pes planus deformity

BackgroundMedializing displacement calcaneal osteotomy is commonly performed as part of reconstructive surgery for patients with valgus hindfoot and progressive pes planus deformity. Among several types of calcaneal osteotomies, the oblique and Chevron osteotomy patterns have been commonly described in the literature and gained popularity as they are easily reproducible through percutaneous techniques. Currently, there is scarce evidence in the literature on which cut pattern is superior in terms of stability. To investigate the impact of cut pattern and posterior fragment medialization level on foot biomechanics, computational methods are employed. MethodsAnkle weightbearing computer tomography (CT) scans of seven patients diagnosed with stage II pes planus deformity are segmented and converted into 3D computational models. Oblique and Chevron osteotomy patterns are modeled independently for each patient. The posterior fragments are medially translated by 8-, 10- and 12-mm and subsequently fixated to the anterior calcaneus with two screws. A total of 42 models are exported to finite element software for biomechanical simulations. Among the investigated parameters, the higher stiffness and lower von Mises stress at the osteotomy interface and the screw site are assumed to be precursors of better stability. ResultsIt is recorded that as the medialization level increases, the stiffness decreases, and overall stresses increase. Also, it is observed that the Chevron cut produces a stiffer construct while the overall stresses are lower, indicating better stability when compared to the oblique cut. The statistical comparisons of the relevant groups that support these trends are found to be significant (p < 0.05). ConclusionChevron osteotomy showed superior stability compared to the oblique osteotomy while underscoring the negative impact of increased medialization of the posterior fragment. Clinical relevanceOpting for a lower medialization level and implementing the Chevron technique may facilitate union and earlier weightbearing.

Biomechanical evaluation of modified and traditional cortical bone trajectory technique on adjacent segment degeneration in transforaminal lumbar interbody fusion—finite element analysis

ObjectivesModified cortical bone trajectory (MCBT) technique was proposed by our team in previous studies, but its biomechanical properties at adjacent segments have not been discussed yet. Therefore, the purpose of this study is to investigate the biomechanical properties of modified cortical bone trajectory (MCBT) technique on adjacent segment degeneration (ASD) in transforaminal intradiscal lumbar disc fusion (TLIF) compare to traditional bone trajectory (TT) technique and cortical bone trajectory (CBT) technique.MethodsThe four human cadaveric lumbar specimens were provided by the anatomy teaching and research department of Xinjiang Medical University and four intact finite element models of the L1-S1 segment were generated. For each of these, three transforaminal lumbar interbody fusion procedures with three different fixation techniques were reconstructed at the L4-L5 segment, as follows: TT-TT (TT at both L4 and L5 segments), CBT-CBT (CBT at both L4 and L5 segments), MCBT-MCBT (MCBT at both L4 and L5 segments). The range of motion and von Mises stress of the intervertebral disc of the L3-L4 and L5-S1 segments were recorded with a 400N compressive load and 7.5 Nm moments in flexion, extension, left–right bending, and left–right rotation.ResultsThe peak ROM of the L3-L4 segment in the MCBT-MCBT group was reduced by 10.5%, 6.1%, 12.2%, 4.1%, and 1.5% in flexion, extension, left–right bending, and left rotation compared to the TT-TT group and reduced by 1.8%, 5.5%, 10.0%, 12.8%, and 8.8% in flexion, left–right bending, and left–right rotation compared to the CBT-CBT group, respectively. The MCBT-MCBT group has the lowest peak ROM of the L3-L4 segment in flexion, left bending, and right rotation, the lowest peak ROM of the L5-S1 segment in extension and right rotation, and the lowest peak von Mises stress of the intervertebral disc at the L5-S1 segment in right rotation compared to the TT-TT and CBT-CBT group. In addition, the peak von Mises stress at the L3-L4 segment was lowest and more dispersed in all motions, the MCBT-MCBT group exhibited lower peak ROM of the L5-S1 segment in flexion, extension, and right rotation, and showed lower peak von Mises stress of the disc at the L5-S1 segment in flexion, extension, and right rotation compared with the TT-TT group.ConclusionThe modified cortical bone trajectory technique may have a beneficial effect on reducing the incidence of ASD in the L4-L5 TLIF model compared to the traditional bone trajectory technique and cortical bone trajectory technique.

How Does the Micro-Groove Profile Influence the Mechanics of Taper Junction in Hip Implants? A Finite Element Study

This study aims to investigate the effect of ridged (micro-grooved) surface finish over the trunnion surface on the mechanics (stress, strain, and deformation) of the head–neck taper interface in hip implants. Using finite element modelling, the study focused on the geometric parameters of such micro-grooves to study how they would mechanically affect stress and deformation fields after the assembly procedure. As such, five different 2D models with varying micro-groove height and spacing were produced and assembled under an impaction assembly force of 4 kN in a 32 mm CoCrMo head engaged with a 12/14 Ti-6Al-4V neck. The results showed that lower von Mises stresses could be induced by either an increase or decrease in spacing against the base model (Model 1), which probably signifies that the relationship between the ridge spacing and stress may depend on the level of spacing. It was concluded that the geometrical parameters of the ridges (and their non-linear interactions) impact not only the stress and strain fields but also the assembly loading time at which the maximal stress and plastic deformation occur.

Lumbosacral spinal proteomic changes during PAR4-induced persistent bladder pain

Repeated intravesical activation of protease-activated receptor-4 (PAR4) in mice results in persistent bladder hyperalgesia (BHA). We investigated spinal proteomic changes associated with persistent BHA. Persistent BHA was induced in female mice by repeated (3x; days 0,2,4; n = 9) intravesical instillation of PAR4 activating peptide (PAR4-AP) while scrambled peptide served as the control (no pain; n = 9) group. The threshold to lower abdominal von Frey stimulation was recorded prior to and during treatment. On day 7, L6-S1 spinal segments were excised and examined for proteomic changes using LC-MS/MS. In-depth, unbiased proteomic tandem-mass tag (TMT) analysis identified and relatively quantified 6739 proteins. We identified significant changes with 29 decreasing and 51 increasing proteins in the persistent BHA group and they were associated with neuroprotection, redox modulation, mitochondrial factors, and neuronal-related proteins. In an additional experiment, decreases in protein levels were confirmed by immunohistochemistry for metallothionein 1/2. Our results show that persistent bladder pain is associated with central (spinal) protein changes. Previous work showed that PAR4-induced bladder pain is mediated, at least in part by spinal MIF. Further functional studies of these top changing proteins may lead to the discovery of novel potential therapeutic targets at the spinal level to modulate persistent bladder pain. Future studies will examine the effect of spinal MIF antagonism on PAR4-induced spinal proteomics associated with persistent bladder pain.

No Increased Incidence of Bleeding in Essential Thrombocythemia Patients with Extreme Thrombocytosis

CONCLUSIONS About 25% of essential thrombocythemia (ET) patients present with extreme thrombocytosis (ExT), defined as having a platelet count ≥1000 x 10^9/L. ExT patients may have an increased bleeding risk, at least in part associated with acquired von Willebrand disease. There are no specific guidelines for managing ExT patients, and many are started on cytoreduction, even if they are younger and otherwise at low thrombotic risk by the revised International Prognostic Score of Thrombosis for ET (R-IPSET). We analyzed the risk of bleeding and thrombosis in ExT vs. non-ExT ET patients to inform treatment decisions. METHODS : We retrospectively analyzed patients who received targeted gene sequencing at Massachusetts General Brigham / Dana-Farber Cancer Institute from 2014-2021 and met WHO 2016 criteria for ET. We performed medical record review and recorded information on treatment, diagnosis, blood counts, and von Willebrand antigen and activity levels. We abstracted the first major bleed, clinically relevant non-major bleed (CRNMB), and thrombotic event in a patient's disease course. Bleeding was categorized using the International Society on Thrombosis &amp; Haemostasis definitions.We determined the cumulative incidence rates of bleeding and thrombosis in ExT and non-ExT patients with death as a competing event and compared these rates using a Gray test. Risk factors for bleeding and thrombosis were evaluated using univariate and multivariate Fine Gray models. We identified 408 patients diagnosed with ET, of which 344 had a platelet count reported at diagnosis. There were 96 ExT patients and 248 non-ExT patients. Median follow-up was 11 and 6 years, and median platelet count at ET diagnosis was 1194 and 651, respectively. ExT patients, compared with non-ExT patients, were more likely to be younger (51 vs. 58 years old, p&amp;lt;.001), have the CALR mutation (49% vs. 23%, p&amp;lt;.001), have lower IPSET-thrombosis risk (65% vs. 49% very low or low risk, p&amp;lt;.001), and have lower von Willebrand activity levels at diagnosis or in disease course (60% vs. 94%, p&amp;lt;.001, Table 1). There were 7 (7%) major bleeds and 7 (7%) CRNMBs in the 96 ExT patients, and 11 (4%) major bleeds and 22 (9%) CRNMBs in the 248 non-ExT patients (p=.29 for major bleeding, p=.83 for CRNMB). 10 year cumulative incidence of major bleed and CRNMB was not different in ExT vs. non-ExT patients (4% vs. 5%, p=.68 for major bleed; 3% vs. 10%, p=.27 for CRNMB, Figure 1). Despite 65% of ExT patients in our sample categorized as very low or low risk for thrombosis, these patients were more likely to be treated with cytoreduction compared to non-ExT patients (63% vs. 50%, p=.21 for very low risk; 81% vs. 51%, p=.022 for low risk). However, there was no difference in the 10 year cumulative incidence of major bleeding and CRNMB in ExT patients who were treated vs. not treated with cytoreduction (6% vs. 0%, p=.13 for major bleed; 2% vs. 8%, p=.13 for CRNMB). There was also no difference in the cumulative incidence of bleeding in ExT and non-ExT patients who were not treated with cytoreduction (untreated or aspirin alone, 0% vs. 4%, p=.34 for major bleed; 8% vs. 9%, p=.75 for CRNMB). In univariate analysis, diabetes mellitus and thrombosis during disease course were significantly associated with increased combined major bleeding and CRNMB. In a multivariable analysis adjusting for these factors in addition to platelet count ≥1000 x 10^9/L and age at ET diagnosis, first von Willebrand factor activity, aspirin and cytoreduction during disease course, and JAK2 mutation status, diabetes mellitus (HR 3.45, 95% CI 1.31-8.72) and thrombosis during disease course (HR 2.92, 95% CI 1.41-6.03) remained as significant risk factors for bleeding. Cytoreduction was not significantly associated with a lower rate of bleeding in multivariable analysis (HR .42, 95% CI .09-3.06). 10 year cumulative incidence of thrombosis was not different in ExT vs. non-ExT patients (22% vs. 26%, p=.94). We found no difference in the cumulative incidence of bleeding and thrombosis in ET patients with ExT and importantly, no clear role for initiation of cytoreductive therapy in these patients who are otherwise low risk by R-IPSET. This confirms the current recommendations to initiate cytoreduction based on thrombotic risk and suggests that ExT alone should not be an indicator for cytoreduction.

Biomechanical feasibility of non-locking system in patient-specific mandibular reconstruction using fibular free flaps

Mandibular reconstruction with free fibular flaps is frequently used to restore segmental defects. The osteosythesis, including locking and non-locking plate/screw systems, is essential to the mandibular reconstruction. Compared with the non-locking system that requires good adaption between plate and bone, the locking system appears to present a better performance by locking the plate to fixation screws. However, it also brings about limitations on screw options, a higher risk of screw failure, and difficulties in screw placement. Furthermore, its superiority is undermined by the advancing of patient-specific implant design and additive manufacturing. A customized plate can be designed and fabricated to accurately match the mandibular contour for patient-specific mandibular reconstruction. Consequently, the non-locking system seems more practicable with such personalized plates, and its biomechanical feasibility ought to be estimated. Finite element analyses of mandibular reconstruction assemblies were conducted for four most common segmental mandibular reconstructions regarding locking and non-locking systems under incisal biting and right molars clenching, during which the influencing factor of muscles’ capacity was introduced to simulate the practical loadings after mandibular resection and reconstruction surgeries. Much higher, somewhat lower, and similar maximum von Mises stresses are separately manifested by the patient-specific mandibular reconstruction plate (PSMRP), fixation screws, and reconstructed mandible with the non-locking system than those with the locking system. Equivalent maximum displacements are identified between PSMRPs, fixation screws, and reconstructed mandibles with the non-locking and locking system in all four reconstruction types during two masticatory tasks. Parallel maximum and minimum principal strain distributions are shared by the reconstructed mandibles with the non-locking and locking system in four mandibular reconstructions during both occlusions. Conclusively, it is feasible to use the non-locking system in case of patient-specific mandibular reconstruction with fibular free flaps based on the adequate safety, comparable stability, and analogous mechanobiology it presents compared with the locking system in a more manufacturable and economical way.

Finite element analysis of lattice designed lumbar interbody cage based on the additive manufacturing.

Additive manufacturing (AM) methods, which facilitate the production of complex structures with different geometries, have been used in producing interbody cages in recent years. In this study, the effects of Ti6Al4V alloy interbody lattice designed fusion cages between the third and fourth lumbar vertebrae where degenerative disc diseases occur were investigated using the finite element method. Face centered cubic (FCC), body centered cubic (BCC), and diamond structures were selected as the lattice structure suitable for the interbody cage. A kidney shaped interbody lumbar cage was designed. The designated lattice structures were selected by adjusting the cell sizes suitable for the designed geometry, and the mesh configuration was made by the lumbar lattice structure. 400 N Axial force and 7.5 N.m moments were applied to the spine according to lateral bending, flexion, and torsion. 400 N axial force and 7.5 N.m flexion moment is shown high strain and total deformation then lateral bending and torsion on BCC FCC and diamond lattice structured interbody cages. In addition, the effects of lattice structures under high compression forces were investigated by applying 1000 N force to the lattice structures. When von Mises stresses were examined, lower von Mises stress and strains were observed in the BCC structure. However, a lower total deformation was observed in the FCC. Due to the design of the BCC and the diamond structure, it is assumed that bone implant adhesion will increase. In the finite element analysis (FEA), the best results were shown in BCC structures.

Development and characterizations of graded porous titanium scaffolds via selective laser melting for orthopedics applications

To improve the treatment effect of bone defect repair, titanium scaffolds having graded structures with porosities of 78.8%, 70.8%, 62.6%, and 54.4% (denoted as P1, P2, P3, and P4, respectively) were designed and fabricated by selective laser melting. The manufacturability, microstructure, mechanical properties, and permeability were investigated theoretically and experimentally. Simulation results showed that the maximum von Mises stress and permeability were in the range of 569.1–1469.0 MPa and (21.7–54.6)×10−9 m2 respectively. Thereinto, P3 and P4 exhibited lower maximum von Mises stress, meaning a higher strength. The microstructure of fabricated scaffolds with P3 and P4 consisted of martensitic α′ phase. The yield strength and elastic modulus were 185.3-250.8 MPa and 6.1-9.7 GPa, respectively. Compared with the scaffold with P3, the scaffold with P4 exhibited higher yield strength and a more matched elastic modulus to cortical bone, and its permeability (18.6×10−9 m2) was within the range of permeability of human bone. Comprehensively, the scaffold with P4 is a promising candidate for bone defect reconstructions.

A Teenage Boy with Systemic Lupus Erythematosus Complicated with Acquired von Willebrand Syndrome: A Rare Case and Challenging in Making Diagnosis

In systemic lupus erythematosus (SLE), haematological abnormalities are frequent, although they are an uncommon cause of acquired von Willebrand syndrome (AVWS). AVWS is a rare condition that can cause a bleeding disorder. We presented a case of AVWS in the early diagnosis of SLE. One month before admission, the patient had a history of recurrent epistaxis. He presented to the hospital with symptomatic anaemia and was noted to have severe anaemia with iron deficiency. During hospitalisation, recurrent epistaxis recurred and was found to have prolonged activated partial thromboplastin time (aPTT), presence of lupus anticoagulant (LA), and lower von Willebrand factor (VWF), and factor 8 (VIII) levels. Simultaneously, he was diagnosed with SLE based on Systemic Lupus International Collaborating Clinics (SLICC) criteria. He underwent blood transfusions and was treated with immunosuppressive drugs such as steroids, mycophenolate mofetil, and an anti-fibrinolytic agent; he subsequently stopped bleeding and showed clinical improvement.