The complex quaternary Ti-35Nb-7Zr-5Ta orthopedic alloy has been successfully deposited from a powder feedstock consisting of a blend of elemental titanium, niobium, zirconium, and tantalum powders, using the laser engineered net-shaping (LENStrade mark) process. In the as laser-deposited form, these alloys exhibit a substantially higher tensile strength as compared with more conventionally processed counterparts of similar composition, while maintaining excellent ductility and a low modulus. Furthermore, the as-deposited alloys appear to exhibit a <001> texture, with a substantially large number of grains of the beta phase aligning one of their <001> axes nearly normal to the substrate or parallel to the growth direction. The microstructure of the as-deposited as well as tensile-tested alloys have been characterized in detail using scanning electron microscopy (SEM), orientation microscopy (OM), and transmission electron microscopy (TEM). Formation of a high density of shear bands, possibly arising from slip localization due to precipitates of the omega phase in the beta matrix, is clearly evident in the tensile-tested sample. The enhanced tensile strength and low modulus in these laser-deposited alloys coupled with the ability to form near-net shape components makes LENS an attractive processing technology for orthopedic implants.
While direct metal deposition of metallic powders, via laser deposition, to form near-net shape orthopedic implants is an upcoming and highly promising technology, the corrosion resistance and biocompatibility of such novel metallic biomaterials is relatively unknown and warrants careful investigation. This article presents the results of some initial studies on the corrosion resistance and in vitro response of laser-deposited Ti-Nb-Zr-Ta alloys. These new generation beta titanium alloys are promising due to their low elastic modulus as well as due the fact that they comprise of completely biocompatible alloying elements. The results indicate that the corrosion resistance of these laser-deposited alloys is comparable and in some cases even better than the currently used commercially-pure (CP) titanium (Grade 2) and Ti-6Al-4V ELI alloys. The in vitro studies indicate that the Ti-Nb-Zr-Ta alloys exhibit comparable cell proliferation but enhanced cell differentiation properties as compared with Ti-6Al-4V ELI.
Introduction of proton pump inhibitor (PPI) therapy into clinical practice has revolutionized treatment approach to acid-related diseases. With its clinical success came a widespread use of PPI therapy. Subsequently, several studies found that PPIs were oftentimes overprescribed in primary care and emergency setting, likely attributed to seemingly low side-effect profile and physicians having low threshold to initiate therapy. However, now there is a growing concern over PPI side-effect profile among both patients and providers. We would like to bring more awareness to the currently available guidelines on PPI use, discuss clinical indications for PPIs and the evidence behind the reported side-effects. We hope that increased awareness of proper PPI use will make the initiation or continuation of therapy a well informed and an evidence-based decision between patient and physician. We also hope that discussing evidence behind the reported side-effect profile will help clarify the growing concerns over PPI therapy.
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