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A home-made 3D Multi-Material Laser Powder Bed Fusion (3DMMLPBF) technology was exploited to manufacture novel multi-material Ti6Al4V-CoCrMo parts. This multi-material concept aims to bring to life a new and disruptive material's design concept for the acetabular cup. Only using a layer-by-layer approach it is possible to manufacture an acetabular cup capable to combine CoCrMo alloy wear resistance and Ti6Al4V alloy bone-friendly nature, in a single component, fabricated at once. This system works with multiple powder deposition functions and vacuum cleaning procedures allowing to use two different powders (Ti6Al4V and CoCrMo) in each layer and thus, allowing to construct 3D Multi-Material transition between distinct materials, point-by-point and layer-by-layer. In this sense, the manufacturing strategies and the functional transition between Ti6Al4V and CoCrMo with a mechanical interlocking were analyzed and discussed both from mechanical and metallurgical point of view. A small diffusion area and no evidence of defects or cracks can be found in the transition's regions between the distinct materials which are strong evidences of a solid metallurgical bonding at the interfacial regions of Ti6Al4V and CoCrMo materials. A functional transition is also obtained through a design capable to provide a 3D mechanical interlocking with potential of assuring, simultaneously, tensile and compressive strength. This proof of concept might be a step-ahead in Laser Powder Bed Fusion in which the most desired intrinsic of individual materials can be combined in a single component targeting biomedical disruptive solutions.

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In this study, Selective Laser Melting (SLM) was used to produce mono-material Ti64Al4V- and NiTi-cubic cellular structures with an open-cell size and wall thickness of 500 µm and 100 µm, respectively. Bioactive beta-tricalcium phosphate (ßTCP) and polymer poly-ether-ether ketone (PEEK) were used to fill the produced structures open-cells, thus creating multi-material components. These structures were characterized in vitro in terms of cell viability, adhesion, differentiation and mineralization. Also, bio-tribological experiments were performed against bovine plate to mimic the moment of implant insertion. Results revealed that metabolic activity and mineralization were improved on SLM mono-material groups, when compared to the control group. All cell metrics were improved with the addition of PEEK, conversely to ßTCP where no significant differences were found. These results suggest that the proposed solutions can be used to improve implants performance.

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Intelligent Reflecting Surfaces (IRSs) are emerging as an effective technology capable of improving the spectral and energy efficiency of future wireless networks. The proposed scenario consists of a multi-antenna base station and a single-antenna user that is assisted by an IRS. The large number of reflecting elements at the IRS and its passive operation represent an important challenge in the acquisition of the instantaneous channel state information (I-CSI) of all links as it adds a very high overhead to the system and requires equipping the IRS with radio-frequency chains. To overcome this problem, a new approach is proposed in order to optimize beamforming at the BS and the phase shifts at the IRS without considering any knowledge of I-CSI but while only exploring the statistical channel state information (S-CSI). We aim at maximizing the user-achievable rate subject to a maximum transmit power constraint. To achieve this goal, we propose a new two-phase framework. In the first phase, both the beamforming at the BS and IRS are designed based only on S-CSI and, in the second phase, the previously designed beamforming pair is used as an initial solution, and beamforming at the BS and IRS is designed only by considering the feedback of the SNR at UE. Moreover, for each phase, we propose new methods based on Genetic Algorithms. Results show that the developed algorithms can approach beamforming with I-CSI but with significantly reduced channel estimation overhead.

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Ti6Al4V sub-millimetric cellular structures arise as promising solutions concerning the progress of conventional orthopedic implants due to its ability to address a combination of mechanical, physical and topological properties. Such ability can improve the interaction between implant materials and surrounding bone leading to long-term successful orthopedic implants. Selective Laser Melting (SLM) capability to produce high quality Ti6Al4V porous implants is in great demand towards orthopedic biomaterials. In this study, Ti6Al4V cellular structures were designed, modeled, SLM produced and characterized targeting orthopedic implants. For that purpose, a set of tools is proposed to overcome SLM limited accuracy to produce porous biomaterials with desired dimensions and mechanical properties. Morphological analyses were performed to evaluate the dimensional deviations noticed between the model CAD and the SLM produced structures. Tensile tests were carried out to estimate the elastic modulus of the Ti6Al4V cellular structures. The present work proposes a design methodology showing the linear correlations found for the dimensions, the porosity and the elastic modulus when comparing the model CAD designs with Ti6Al4V structures by SLM.

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Nickel-titanium (NiTi) cellular structures are a very promising solution to some issues related to orthopaedic implant failure. These structures can be designed and fabricated to simultaneously address a combination of mechanical and physical properties, such as elastic modulus, porosity, wear and corrosion resistance, biocompatibility and appropriate biological environment. This ability can enhance the modest interaction currently existing between metallic dense implants and surrounding bone tissue, allowing long-term successful orthopaedic implants. For that purpose, NiTi cellular structures with different levels of porosity intended to reduce the elastic modulus were designed, modelled, selective laser melting (SLM) fabricated and characterized. Significant differences were found between the CAD design and the SLM-produced NiTi structures by performing systematic image analysis. This work proposes designing guidelines to anticipate and correct the systematic differences between CAD and produced structures. Compressive tests were carried out to estimate the elastic modulus of the produced structures and finite element analyses were performed, for comparison purposes. Linear correlations were found for the dimensions, porosity, and elastic modulus when comparing the CAD design with the SLM structures. The produced NiTi structures exhibit elastic moduli that match that of bone tissue, which is a good indication of the potential of these structures in orthopaedic implants.

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Bone is a dynamic tissue with an amazing but yet limited capacity of self-healing. Bone is the second most transplanted tissue in the world and there is a huge need for bone grafts and substitutes which lead to a decrease in bone banks donors. In this study, we developed three-dimensional scaffolds based on Ti6Al4V, ZrO2 and PEEK targeting bone tissue engineering applications. Experimental mechanical compressive tests and finite element analyses were carried out to study the mechanical performance of the scaffolds. Overall, the scaffolds presented different hydrophilicity properties and a reduced elastic modulus when compared with the corresponding solid materials which can in some extension minimize the phenomenon of stress shielding. The ability as a scaffold material for bone tissue regeneration applications was evaluated in vitro by seeding human osteosarcoma (SaOS-2) cells onto the scaffolds. Then, the successful culture of SaOS-2 cells on developed scaffolds was monitored by assessment of cell's viability, proliferation and alkaline phosphatase (ALP) activity up to 14 days of culturing. The in vitro results revealed that Ti6Al4V, ZrO2 and PEEK scaffolds were cytocompatible allowing the successful culture of an osteoblastic cell line, suggesting their potential application in bone tissue engineering. Statement of Significance. The work presented is timely and relevant since it gathers both the mechanical and cellular study of non-degradable cellular structures with the potential to be used as bone scaffolds. This work allow to investigate three possible bone scaffolds solutions which exhibit a significantly reduced elastic modulus when compared with conventional solid materials. While it is generally accepted that the Ti6Al4V, ZrO2 and PEEK are candidates for such applications a further study of their features and their comparison is extremely important for a better understanding of their potential.

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Orthopedic implants are under incessant advancement to improve their interactions with surrounding bone tissue aiming to ensure successful outcomes for patients. A successful biological interaction between implant and surrounding bone depends on the combination of mechanical, physical and topological properties. Hence, Ti6Al4V cellular structures appear as very promising solutions towards the improvement of conventional orthopedic implants. This work addresses a set of fundamental tools that allow improving the design of Ti6Al4V cellular structures produced by Selective Laser Melting (SLM). Three-point bending tests were carried out to estimate the elastic modulus of the produced structures. Morphological analysis allowed to evaluate the dimensional differences that were noticed between the model CAD and the SLM structures. Finite element models (adjusted CAD) were constructed with the experimentally obtained dimensions to replicate the mechanical response of the SLM structures. Linear correlations were systematically found for the dimensions of the SLM structures as a function of the designed model CAD dimensions. This has also been observed for the measured porosities as a function of the designed CAD models. This data can be used in further FE analyses as design guidelines to help engineers fabricating near-net-shape SLM Ti6Al4V cellular structures. Besides, polished and sandblasted surface treatments performed on the Ti6Al4V cellular structures allowed to obtain suitable properties regarding roughness and wettability when compared to as-produced surfaces. The capillarity tests showed that all the analyzed Ti6Al4V structures are able to transport fluid along its structure. The cell viability tests demonstrate Ti6Al4V cellular structures SLM produced did not release toxic substances to the medium, indicating that these structures can assure a suitable environment for cells to proliferate and attach. This study proposes a design methodology for Ti6Al4V cellular structures, that owe suitable mechanical properties but also provide a proper combination of porosity, roughness, wettability, capillarity and cell viability, all of them relevant for orthopedic applications. A Ti6Al4V cellular structured hip implant prototype gathering the suitable features addressed in this study was successfully SLM-produced.

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O presente estudo teve como finalidade analisar as intervenções fisioterapêuticas na melhora do equilíbrio em idosos com Diabetes mellitus tipo 2. Foi realizada uma revisão sistemática dos estudos publicados até junho de 2016 nas bases de dados eletrônicas PubMed, Scielo e Lilacs; nos meses de maio e junho de 2016, usando os seguintes descritores: "Balance", "Elderly", "Diabetes Mellitus type 2" e "Falls" . Foram encontrados 71 artigos. Após a aplicação dos filtros restaram 15 artigos. Na obtenção da amostra, deveriam ser obedecidos critérios de inclusão previamente definidos. Após a análise dos resumos, 5 estudos randomizados controlados foram selecionados para análise dos seus dados. Entre os 5 estudos selecionados, o número da amostra variou de 37 a 71 pacientes, totalizando 250 participantes. A média de idade variou de 57 a 79 anos. Dois artigos utilizaram intervenção incluindo exercícios de marcha e equilíbrio com fortalecimento. Enquanto um utilizou programa de Whole-body vibration (WBV) seguido por exercícios na plataforma vibratória, outro aplicou jogos de vídeo VRE (PlayStation 2; Sony, Tóquio, Japão) e um estudo apresentou intervenção de treino com exercícios aeróbios. As três variáveis mais analisadas nos estudos selecionados foram: equilíbrio, risco de quedas e marcha. Dois estudos avaliaram a força muscular e um a mobilidade articular. Após a análise dos achados desta revisão, conclui-se que os artigos apresentam diferentes intervenções fisioterapêuticas que interferem positivamente no equilíbrio produzindo resultados encorajadores na diminuição do risco de queda em indivíduos com DM2. Estes resultados têm implicações importantes para a prevenção de quedas em pacientes com DM2 em cuidados de atenção primária em saúde....(AU)

The present study aimed to analyze the physiotherapeutic interventions to improve balance in elderly with type 2 Diabetes mellitus. A systematic review of the studies published until June 2016 in the electronic databases PubMed, Scielo and Lilacs; in the months of May and June 2016, using the following descriptors: "Balance", "Elderly", "Diabetes Mellitus type 2" and "Falls". 71 articles found. After the filters were applied 15 articles remained. In obtaining the sample, previously defined inclusion criteria should be obeyed. After analysis of the abstracts, 5 randomized controlled trials were selected to analyze their data. After analysis of the abstracts, 5 randomized controlled trials were selected to analyze their data. Among the 5 selected studies, the sample number ranged from 37 to 71 patients, totaling 250 participants. The mean age ranged from 57 to 79 years. Two articles used intervention including gait and balance exercises with strengthening. While one used a Whole-body vibration (WBV) program followed by exercises on the vibrating platform, another applied VRE video games (PlayStation 2, Sony, Tokyo, Japan) and a study presented training intervention with aerobic exercises. The three variables most analyzed in the selected studies were: balance, risk of falls and gait. Two studies evaluated muscle strength and joint mobility. After analyzing the findings of this review, it is concluded that the articles present different physiotherapeutic interventions that interfere positively in the balance, producing encouraging results in reducing the risk of falls in individuals with T2DM. These results have important implications for the prevention of falls in patients with T2DM in primary health care....(AU)

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SLM accuracy for fabricating porous materials is a noteworthy hindrance when aiming to obtain biomaterial cellular structures owing precise geometry, porosity, open-cells dimension and mechanical properties as outcomes. This study provides a comprehensive characterization of seventeen biomaterial Ti6Al4V-based structures in which experimental and numerical investigations (compression stress-strain tests) were carried out. Mono-material Ti6Al4V cellular structures and multi-material Ti6Al4V-PEEK cellular structures were designed, produced by SLM and characterized targeting orthopedic implants. In this work, the differences between the CAD design and the as-produced Ti6Al4V-based structures were obtained from image analysis and were used to develop predictive models. The results showed that dimensional deviations inherent to SLM fabrication are systematically found for different dimensional ranges. The present study proposes several mathematical models, having high coefficients of determination, that estimate the real dimensions, porosity and elastic modulus of Ti6Al4V-based cellular structures as function of the CAD model. Moreover, numerical analysis was performed to estimate the octahedral shear strain for correlating with bone mechanostat theory limits. The developed models can help engineers to design and obtain near-net shape SLM biomaterials matching the desired geometry, open-cells dimensions, porosity and elastic modulus. The obtained results show that by using these AM structures design it is possible to fabricate components exhibiting a strain and elastic modulus that complies with that of bone, thus being suitable for orthopedic implants.

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Load-bearing implants success is strongly dependent on several physical and chemical properties that are known to drive cellular response. In this work, multi-material ß-TCP-Ti6Al4V cellular structures were designed to combine Ti6Al4V mechanical properties and ß-Tricalcium Phosphate bioactivity, in order to promote bone ingrowth as the bioactive material is being absorbed and replaced by newly formed bone. In this sense, the produced structures were characterized regarding roughness, wettability, ß-TCP quantity and quality inside the structures after fabrication and the pH measured during cell culture (as consequence of ß-TCP dissolution) and those aspects were correlated with cellular viability, distribution, morphology and proliferation. These structures displayed a hydrophilic behavior and results showed that the addition of ß-TCP to these cellular structures led to an alkalization of the medium, aspect that significantly influences the cellular response. Higher impregnation ratios were found more adequate for lowering the media pH and toxicity, and thus enhance cell adhesion and proliferation.

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The following study proposes a multi-material solution in which Ti6Al4V cellular structures produced by Selective Laser Melting are impregnated with bioactive materials (hydroxyapatite or ß-tricalcium phosphate) using press and sintering technique. To assess the tribological response of these structures, an alumina plate was used as a counterpart in a flat-on-flat reciprocating sliding test. Ti6Al4V cellular structures impregnated with bioactive materials displayed the highest wear resistance when compared with the unreinforced structures. Among the bioactive structures, Ti6Al4V cellular structures impregnated with ßTCP were the ones with higher wear resistance, having the lowest weight loss. Hence, these structures are promising multifunctional solutions for load-bearing applications by gathering suitable mechanical properties (strength and stiffness); bioactive properties and in addition an improved wear performance.

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Ti6Al4V-alloy is commonly used in dental and orthopedic applications where tribochemical reactions occur at material/bone interface. These reactions are one of the main concerns regarding Ti6Al4V implants due to the generation of wear particles, linked to the release of metallic ions in toxic concentration which occurs when TiO2 passive film is destroyed by means of wear and corrosion simultaneously. In the present study, a multi-material Ti6Al4V-PEEK cellular structure is proposed. Selective Laser Melting technique was used to produce Ti6Al4V dense and cellular structured specimens, whilst Hot-Pressing technique was employed to obtain multi-material Ti6Al4V-PEEK structures. This study investigates the tribocorrosion behavior of these materials under reciprocating sliding, comparing them with commercial forged Ti6Al4V. Open-circuit-potential was measured before, during and after sliding while dynamic coefficient of friction was assessed during sliding. The results showed an improved wear resistance and a lower tendency to corrosion for the multi-material Ti6Al4V-PEEK specimens when compared to dense and cellular structures mono-material specimens. This multi-material solution gathering Ti6Al4V and PEEK, besides being able to withstand the loads occurring after implantation on dental and orthopedic applications, is a promising alternative to fully dense metals once it enhances the tribocorrosion performance.

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Additive manufacturing (AM) technologies enable the fabrication of innovative structures with complex geometries not easily manufactured by traditional processes. Regarding metallic cellular structures with tailored/customized mechanical and wear performance aiming to biomedical applications, Selective Laser Melting (SLM) is a remarkable solution for their production. Focusing on prosthesis and implants, in addition to a suitable Young's modulus it is important to assess the friction response and wear resistance of these cellular structures in a natural environment. In this sense, five cellular Ti6Al4V structures with different open-cell sizes (100-500µm) were designed and produced by SLM. These structures were tribologicaly tested against alumina using a reciprocating sliding ball-on-plate tribometer. Samples were submerged in Phosphate Buffered Saline (PBS) fluid at 37°C, in order to mimic in some extent the human body environment. The results showed that friction and wear performance of Ti6Al4V cellular structures is influenced by the structure open-cell size. The higher wear resistance was obtained for structures with 100µm designed open-cell size due to the higher apparent area of contact to support tribological loading.

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