An athlete with torn ligaments. A patient with walking difficulties. And two victims of a car accident.
They all have serious health issues. But they are also hoping for a common cure. Intelligent fibre disperse in a magnitude of materials, which will save their lives, either today or tomorrow!
This is something we'll talk about next! STRENGTH LIGHTNESS TOUGHNESS LONGEVITY THE EXTRAORDINARY WORLD OF FIBRE Surgery had been scheduled for a while, but the day to go to the Hospital has finally arrived. Filipe has been complaining for months of recurring pain on his right leg.
He went to the doctor and found out that his problem was much more complicated than Myositis. He can't escape from surgery. The anaesthesiologist is waiting in the OR with the proper equipment.
Scrubbing is mandatory in here. Surgery is a delicate procedure during which the patient's organism is exposed to the exterior. That is why you have to do everything in order to keep the OR sterile.
We're very demanding when it comes to scrubbing. And we have to be particularly demanding in vascular surgeries, since we're dealing with blood, and circulating blood, where any micro-organism can cause a very serious infection. So, you have to be very careful.
After scrubbing in, putting on the overall, and the gloves, Nurse Roberto is responsible for unpacking the surgical clothing packs, which include the doctor's overalls, and the surgical drapes placed over the patient marking the area for incision. Even though they don't look like it, these blue covers are nonwoven fabric. Disposable fibres, which make up a wall against any contaminations.
The reason is to clearly have a greater protection wall. Not only the doctors, but medical equipment has to be extremely clean as well! The equipment, tables, chairs, and machines are not sterile!
Therefore, these materials have the effect of a wall that is much superior to conventional fabrics. So, things come in a complete package, this package is then unfolded and it has all the surgical drapes to be used. These ensure better sterilisation.
In this case, the clothes worn in Filipe's surgery were made by FAPOMED, which specialises in disposable nonwoven fabric for surgical use. They are authentic protection walls using fibre strength. The most used fibres, bearing in mind that each fibre may be applied for different uses, different walls, or even different constructions, are polypropylene and polyester.
In most cases, the fibre of choice is polypropylene, which is employed using two different manufacture techniques. The central layer is a dense nest of short fibres randomly laid using the MeltBlown manufacture method. This structure makes such a labyrinth that it becomes the perfect wall for any micro-organism.
On both sides of this firewall, there are two nonwoven fabrics manufactured using Spundbond. Here, polypropylene fibres are longer, and are better organised, thus reinforcing the entire structure. This sandwich is called SMS because it combines the three layers in this order: spundbond, meltblown, and spundbond.
After knowing the raw materials' DNA, we can finally understand how these surgical drapes are made. The computer-assisted design room holds the designs for all products produced by Fapomed. And there are many of them.
At least 800 different references. From a digital design, coordinates are sent to an automatic cutter that marks the surgeon's operating window. After having been cut, the pieces enter a clean room with a controlled environment where 80 employees do the patchwork.
Here, several important accessories are placed on the surgical drapes. It includes bags for collecting liquid, bags for the medical team to place their instruments. Incisions that clearly mark the area where the medical team will be performing surgery.
Placing cable knockouts. This organises the medical team's working plan. Then, two employees will carefully fold each drape.
And this isn't a random act, it has all been thought carefully as to prevent any contamination. You cannot make sudden movements when opening the surgical drapes. It must be clearly identified for the user to hold and open it in order to maintain the working area clean.
Either by covering a table or covering the patient. You cannot touch the wrong parts. That's identified.
And that's the work we do for it to be used properly. A bad use of the surgical drapes will make it impossible to use the drapes. After being packed, they only need to be sterilised.
This takes place outside the company, in a vacuum chamber, by using ethylene oxide. It's injected into the products through the membranes. So, it goes through plastic, through the boxes, and through nonwoven fabric, in order to sterilise the products.
At the Lab, clinical analyses are made on the bacterial flora that exists in the different locations of production. This way, the company is well aware of the level of microbial contamination and will adjust all parameters for a perfect sterilisation. All this meticulous care, from the beginning to the end of the factory's surgical drapes, has a very clear goal.
Patients like Filipe Soutinho are in Hospital to solve their health issues rather than returning home with a new disease. We've been introduced to him in previous sports. Besides surfing, Helder is also passionate about football.
But the number one sport isn't for anyone. Each athlete must be sufficiently resistant to keep up for 90 minutes and tenacious enough to run forward and backward along the opposite team. In each game, the body is subjected to unprecedented stress, which may take the cardiovascular and skeletal muscle system to the limit.
This time, Helder really believed he'd won the game. But a misstep was all it took for an injury. A simple sprain on his left knee was too violent for the cruciate ligaments One of them didn't resist.
And that's how the most common injury in sports took place: torn ligaments. This injury doesn't necessarily happen to high level competitive athletes. It shows up on a daily basis due to simple movements like putting your foot down the wrong way on a step.
And there are two very important points to this injury: on one hand, it makes you functionally incapable, that is, the injured knee may become painful and incapable of doing simple daily activities, while at the same time, it may entirely inhibit sports activities that will make you knee rotate and twist. Now that the harm is done, the only way to return his knee's functions is through surgery. Luckily, Helder's in good hands.
Dr Espregueira Mendes has operated hundreds of athletes around the world returning them to sport events when it seemed impossible to many. In this surgery, he'll use an extract of the patient's rotulian tendon, in order to replace the injured ligament. This structural exchange will take place by means of an arthroscopy.
A surgery performed to the knee using a camera and endoscopic tools. There are as little incisions as possible and a faster recovery. The advantage of arthroscopy is that it's not very invasive.
It provides an easier view, since we can see the inside of the knee on the screen. The size of the image is increased, and we can easily change its colour, tone, zoom in, or zoom out, therefore, we can improve the image's quality. Its final, and most important, advantage is that you don't feel much pain because it's not very invasive, and it also limits the size of the scars.
This surgery has great advantages in terms of tissue compatibility because it's an auto-graft, but it's far from being perfect, since there is the need to damage a healthy structure. As an alternative, there are non-degradable synthetic prostheses, with limited validity, and materials that end up not resisting fatigue. In order to get around these obstacles, a multidisciplinary team with the know-how of Biomedical Engineering, Textiles, and Chemistry, is studying an alternative.
The goal of André Vieira's group is to produce an artificial ligament that will make it easier for these structures to recover. Our solution is a degradable one. So, this means that the material will perform temporarily, and will gradually transfer its functions to the biological tissue growing over that material, which will grow as the device will degrade.
In order for us to understand how it will work, this team has prepared a close model to the final ligament. Juliana Cruz is a textile engineer and is installing a polydioxanone yarn coil into a vertical braiding machine. The ligament starts gaining shape through the organised choreography of the several coils around the yarn.
In this case, we're working on several structures, that is, we're dividing those same braids, or rope, into two parts, where we have an external model, which is intertwined, thus creating several angles in-between those twists. But we also work on the inside of that same rope. These two combinations may result in the perfect performance for us.
The mechanical behaviour of a natural ligament is non-linear. So, if I stretch a ligament or any other soft tissue, it will be very easy and flexible at first. But as I stretch it, it will become stiff and more difficult to deform.
We can only copy this type of behaviour by resorting to textiles. Such as ropes, which we're using, or fabric, where we are able to achieve this type of behaviour. So, we have to work on several aspects, and with a braiding machine, it's not only about the yarn or the raw material, which will provide us with those properties, but it's also about the structures.
Many times, the structure is the secret to this curve and mechanical behaviour The porous coating of the rope is also developed as to enable cell migration into this structure, which by the end of the year must be fully absorbed. In order to validate this theory, Joana Vieira tests the chemical and structural degradation of different ligaments as to define a balance between materials and twists. If it degrades too quickly, the injured ligament being treated will be unsupported.
But if it degrades too slowly, it will be supported for too long and the ligament will end up not getting its initial properties back. In the Lab, Joana will place the rope samples in a PH 7. 7 liquid at a temperature of 98.
6 ºF, which is the same as the inside of a knee. After several weeks, the samples are re-evaluated and tested many times in order to calculate loss of mass and changes in mechanical performance. We're still at a stage where we're doing a lot of fundamental research.
So, we're developing materials, solutions, rope models, and models simulating a degradable structure. And now we need to work on the coating, work on bone fixation, and implant them on animals. There's still a long way to go before it reaches the market.
For now, Helder must be happy with the replacement of the injured ligament with his own graft, which is already in place. A simple Echo-Doppler analysis was enough to realise that his blood flow was not within the normal parameters. He has been diagnosed with an external iliac artery stenosis.
An aneurism is a pouch. It is a dilation that appears on the aorta's wall, which forms a pouch with a vulnerable wall. There is a risk of this aneurism pouch bursting, which will result in a cataclysmic bleeding.
Most times it is fatal! We must separate this disease from the artery stenosis going to the members, particularly the iliac and femoral arteries. It's not exactly a pouch in there.
It's an obstruction. I usually tell my patients that it's like a machine pipe with calcium inside, where the blood has difficulty flowing. It has difficulty flowing through that path and reaching the necessary areas.
If barely oxygenated, the muscles will cause intermittent limping. These is the pain that Filipe feels after walking dozens of feet. In these cases, the solution is to use endo-vascular prostheses made from fibres enabling the normal blood flow to be re-established in the damaged arteries.
This is the most critical moment of surgery. Led by an angiography, which is nothing more than a structural artery map, the surgeon will introduce the catheter up to the narrowing point. There's no room for doubts or oscillation.
The stent must be placed exactly at the right location. There may be issues with the endo-vascular repair. That is, the stent graft may move, there may be leaking due to the aneurism pouch not being de-pressurised.
We're introducing a mechanism that will enable us to easily know in a simple manner, without exams, whether the Stent Graft is in place. This solution, developed by Luis Rocha, consists in placing flexible nano-composites in the stent grafts. One of the vital ingredients of this technology are carbon nanotubes.
These nanofibres are produced using a chemical vapour deposition process. This is carried out on a silicon plate with a metal catalyst, which is placed inside an oven, filled with ethylene gas, and heated at 1292 ºF. After 10 to 40 minutes, the nanotubes are deposited on the silicon plate.
Then researcher Alexandra Sepulveda will apply a layer of polydimethylsiloxane on this material. And that's how you produce a nano-composite, which will work as one of the sensor's electrodes. We can basically think that we have two plates, two plates, or micro-plates, or small plates that are parallel to each other and we can say that when pressure changes these plates will move away from each other.
And we're basically measuring them moving away. We can imagine two parallel plates, next to each other, they move away from each other, and we can measure from the exterior how far those plates move. And those plates move depending on the pressure value.
The sensor alone is useless. In order for it to work, it needs an external telemetry device developed by the School of Engineering of Universidade do Porto, which shall be responsible for reading and interpreting the sensor's pulse. By using this telemetry device, we can simultaneously energise the sensors inside, and externally read their value.
This technology has everything to be susccessfull. But it won't work if the stent grafts aren't able to support the sensors. In order to make sure that both elements are compatible, Alexandra Rodrigues' team has been getting better acquainted with the fibres used in these prostheses.
We have to understand the exact textile behaviour, and the influence of fibres on textiles: their dimensions, space, and compaction. So that we'll know the best way to include the sensor in the prostheses. Only after knowing the fabric's structure and the monofilament section, traction tests may take place, with and without the sensors.
We watched the first test. We noticed that the sensor broke on the stitches. So, we've realised that we'll have some issues when using yarn.
We'll have to think of other ways to connect the sensor to the prostheses. But we're still at the initial stages of the project, we'll have to develop a better way to connect the sensor to the prostheses, but we'll work on that step by step. If this integration works, angioplasties where stent grafts will be placed will become even simpler, more efficient, and particularly safer.
Sutures are also being made by materials absorbed by the human body. One of them is chitosan, which is made from chitin, the second most common biopolymer in nature, which is also present in shrimp shells. Chitosan, which is obtained from that same chitin, has a series of biological, chemical and physical properties, and it is easy to handle.
It's easy to build in several types of structure. There's a long road between a shrimp and chitosan. After being frozen, the shells are washed, and repeatedly crushed until you achieve a thin powder.
In another room, this powder is introduced in a reactor and subjected to two chemical processes. The powder is demineralised in an acid solution. Then deproteination is catalysed in a basic solution.
The result of these reactions is pure chitin, which is precisely the material Ana Espiga used to make stitches. We started developing the fibre technique and production as a stitch that doesn't need to be removed, or doesn't need a second intervention, since both external and internal stitches will be absorbed. Inside a clean room, Ana begins by mixing chitosan powder in an acid solution, where it will be dissolved in a liquid that is sticky enough to be handled.
Three millilitres of this material will be placed inside a syringe, which will play the lead role in the wet spinning process. We're simply misplacing the pH. That is, the chitosan is soluble in an acid environment, but insoluble in a basic environment: it precipitates, it coagulates.
And it turns into a gel. When it is being injected into a can with a solution that will result in coagulation, that is, a basic solution, because it's being injected as a stitch, it will become solid, and turn into a gel along with that same structure. With the fibre's structure.
All this know-how was developed by Ceramed during a research with the School of Sciences and Technology of Universidade Nova de Lisboa. After it's been mastered, it is time to move on from techniques to practice. When these stitches become usual in surgeries, patients will no longer have to return to the Hospital to remove stitches, since they will naturally disappear.
On the final episode we witnessed this couple's accident. Time is a critical factor. That's why Hospitals have a green pass for these cases.
In the E. R. , the medical team request an MRI in order to know if there is brain damage.
The problem is that some traumas are not detected in this image. Brain damage is the main cause of death in the industrial world, with 51 million new cases every year. There's no immediate biologic diagnosis from conventional methods, such as a CT scan or MRI.
Walter Schneider seems to have an answer to this challenge. This researcher spends his life re-imagining the brain. He has perfected a technology where, through the movement of water molecules in the axons, he'll extrapolate a high-definition 3D image of the brain's fibre structures.
Raul Fangueiro is faced with an important challenge: to build an artificial brain. These are hollow fibre structures copying the brain axons, which will serve as a reference in order to calibrate this technology. First I'll select the most interesting fibres for this specific application.
Then those fibres are structures in order to copy the brain connections, which is obviously led by those who know exactly the human brain, and those are our colleagues at the University of Pittsburgh. There will be many relevant benefits with this model. This HD Tractography will come out even stronger with the advantages of an early assessment of damages, which you almost don't see using the current devices.
Fortunately for Renato and Diana, the accident didn't cause any permanent injuries. They will only need a few days to heal some wounds and a few broken ribs. As we've observed, patients around the world have to go to Hospital to be treated using fibres formulated with high technology!
In the OR, there is a lower risk of infection due to disposable nonwoven fabric, while new biomaterials are revolutionising the body's recovery from the most complex pathologies. This is the state-of-the-art of fibres applied to medicine, and, as we can see, the future is very close to our reality. In the case of Helder Tavares, the future is now.
Three months after the surgery where he had his injured ligament replaced, he is now ready to play his first game with a new knee. His game is almost starting, as our trip to the Extraordinary World of Fibre will stop here for today.
