Antiadhesion Function between a Biological Surface and a Metallic

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Antiadhesion Function between a Biological Surface and a Metallic Device Interface at High Temperature by Wettability Control Jun-Yong Park, Mizuki Tenjimbayashi, Jun Muto, and Seimei Shiratori ACS Biomater. Sci. Eng., Just Accepted Manuscript • DOI: 10.1021/acsbiomaterials.8b00387 • Publication Date (Web): 12 Apr 2018 Downloaded from http://pubs.acs.org on April 13, 2018

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ACS Biomaterials Science & Engineering

Antiadhesion Function between a Biological Surface and a Metallic Device Interface at High Temperature by Wettability Control Jun-Yong Park1, Mizuki Tenjimbayashi1, Jun Muto2, Seimei Shiratori 1, * 1.

Center for Material Design Science, School of Integrated Design Engineering, Keio University, 3-14-1 Hiyoshi, Yokohama, 223-8522, Japan.

2.

Department of Neurosurgical Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

Corresponding Author: [email protected]

KEYWORDS: Antiadhesion, high temperature, electrosurgery device, bipolar forceps, hydrophobic, superhydrophobic, wettability control.

ACS Paragon Plus Environment

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ABSTRACT

During operations, medical doctors use various medical equipment that is mainly manufactured from metallic materials. Bipolar forceps are used for electrosurgery, especially neurosurgery. Bipolar forceps are utilized for cutting, inosculation, and quick hemostasis with electricity. Because bipolar tips reach a high temperature, the tissue that makes contact with the tips and nearby tissue is damaged. In addition, operations are delayed because of the need to wash or change equipment because of tissue adhering to the bipolar tips. Herein, we designed bipolar forceps with antiadhesion properties by coating them with a superhydrophobic material. We compared the effect of the coating by using bipolar forceps in different tissue samples and target areas, which reached different surface temperatures. Furthermore, the effect of the surface wettability was investigated. The temperature measurements and adhesion force measurements indicated that coating of the sample significantly limited the temperature increase and reduced the adhesion force. We demonstrated that the antiadhesion properties depended on the change in the surface tension of the hydrophobic material coating. These coatings are promising for decreasing tissue adhesion on metallic devices and decreasing collateral heat damage to the tissue.

1. INTRODUCTION Electrosurgery is the application of electrical energy such as high-frequency (radio frequency) alternating polarity or electrical current to biological tissue including normal or diseased tissue.1 It is used to control bleeding, cut, fulgurate tissue.2-5 Electrosurgery is simple to perform and is a procedure that can be readily mastered. Because of these reasons, electrosurgery is used in a


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wide range of treatments, during surgical operations to prevent blood loss in the operation rooms and patient clinics. Its benefits include the ability to make precise cuts with limited blood loss.6 However, repeated coagulations cause the attachment of tissue on the tip of bipolar forceps and burned tissue is attached to the tip, at which decreased coagulation of tissue or blood. 7,8 From this reason, bipolar forceps should be changed to new one or washed well by water while the medical operation, which prevent the smooth medical treatment. This has been a difficult problem that has not been solved so far. The urgent necessity of cleaning the tips of bipolar forceps leads to suspension and prolongation of operation, which may cause to the delay of hemostasis and the contamination of the blood during the medical treatment. This phenomenon is caused by the increase in the temperature of the tips of electrical-energy-based instruments.9 Medical treatment in the operation room require an accurate and quick hemostasis by bipolar forceps.10,11 In 1940, Greenwood reported and developed the first bipolar coagulation system,12 and since then, several bipolar forceps have been developed in which the tips are protected from the attachment of burned tissue.13-15 All of these inventions prevent the heating up of the tips. The adhesion of tissue on the tip of bipolar forceps may increase the temperature to 70–80 °C.16 The tips coated with Isocool™ do not heat up higher than 80 °C.13 Bipolar forceps with a high frequency (4 Hz) heat up less, which prevents coagulation by avoiding the adhesion of tissue.13 Several methods such as the addition of anti-inflammatory agents,17,18 antibiotics,19,20 barrier,21-26 fibrinolytic agents,27,28 coatings,29-31 or films,32-34 and cooling the surface of electrosurgical instruments by spraying with water have been used to prevent the adhesion of tissue on electrosurgical instruments.35-37 The addition of agents is not effective for reducing the adhesion of tissue because they are quickly removed from the surface. Gold and silver are usually used for coating, which are expensive for preventing adhesion of tissue.


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Polytetrafluoroethylene (PTFE) has been used as a film; however, PTFE films are not stable under the high temperature and decompose to toxic gas and particulates in our body.38,39 The spraying of bipolar forceps with cooling water maintains the circulation of water and prevents heating up of the tip. However, it is difficult to control the evaporation of cooling water that is sprayed for cooling of the tips; furthermore, boiling water on the surface of tissue and the evaporation of water creates bubbles on the surface of the tissue. Soft tissue is damaged from the bursting of the bubbles. Recently, Zhang et al. developed liquid-infused surfaces (LIS) for antiadhesion at high temperature.40 The preparation of LIS was a little complicated and required the use of materials that are not safe for humans and for use in medical equipment. To the best of our knowledge, there are no previous reports of antiadhesion using superhydrophobic or hydrophobic surfaces. In the terms of antiadhesion and antifouling, several biomimetic surfaces such as superhydrophobic surfaces, 41-49 slippery liquid infused porous surfaces50,51 have been developed rapidly in recent years. These surfaces were inspired by mimicking the surface morphology of natural plant such as lotus leaf, nepenthes. Wettability control is influenced by not only surface morphology but also materials. In previous research, surface hydrophobicity was used by controlling from materials.52,53 Bio-related nanomaterials that modified DNA and cell-related macromolecular nanoarchitectonics are reported for advanced biofunction application such as targeted drug delivery, artificial organs.54 Superhydrophobic coatings have been used in various applications including waterproof surfaces,55 antireflective,56 anticorrosion or anti-icing,57 antifogging,58 antibacterial and medical devices.59,60 In the surgical procedure, there are water rich environment and wet surface tissue. As mentioned above, these conditions caused several disadvantages during the progress of an


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operation (boiling water and creation of bubbles). Because of these reasons, we focused on superhydrophobic coating for antiadhesion of tissue and resistance to surface wetting under water-rich environment. In this article, first, we used the medical equipment called bipolar forceps in the field of “neurosurgery” for improving the effect of tissue adhesion and for reducing medical errors during surgery. Also, in our experiment, the measured surface temperature is the exact surface temperature on real bipolar forceps tips and not on flat metal substrate. Although the experiment was not human brain or tissue, this work precisely described the disadvantages of tissue adhesion. Second, we developed coating method for wettability control. the coating method is very simple one step process: just spray on the surface. This offers increasing application for wide field where urgent and rapid situation are required. Third, we used a superhydrophobic coating to prevent the heating up of the tips and attachment of the burned tissue and to lower the adhesion of tissue on the tips of bipolar forceps without raising the temperatures at the tip. Fourth, we used dried surface coating using human friendly material. since the surface was dried solid, the coated material will not easily diffuse to biological body. Since we do not use toxic material such as lubricant which may easily be removed by adhesion or abrasion during operation, we do not have to worry about using for medical treatment of human-body. The properties of these materials are suitable for use on other surgical equipment used in medical operations.

2. EXPERIMENTAL SECTION Materials. We used a hydrophobic aerosol spray (hexamethyldisilazane-modified SiO2 nanoparticles) in an ethanol dispersion (SNT Co., Kawasaki, Japan). We purchased the pig liver


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and chicken wings (for weight and temperature measurements), chicken breast meat (for adhesion force measurements) from a commercial store.

Weight change and temperature measurements. We performed adsorption experiments with bipolar forceps (BF-01, Chistop, iMed Japan Inc., Chiba, Japan). These experiments were performed to measure the difference in weight of the bipolar forceps and the temperature of the bipolar tips. The bipolar forceps were used to make contact with 5 different areas: pig liver, chicken wing (blood tube, under the skin, muscle, and skin). First, we measured the weight of the bipolar forceps 3 times using a microbalance. After the bipolar forceps after the bipolar forceps made contact with the 5 different areas, we confirmed the weight change of the bipolar forceps using the same procedure. At the same time, when a current was flowed to the bipolar tips, we measured the change in temperature of the tips. The coated bipolar forceps also measured weight and temperature after coating as same as mentioned above. We changed the power of the bipolar forceps used in the different areas.

Coating on the bipolar forceps tips and stainless-steel plate. We sprayed a hydrophobic aerosol spray on the bipolar forceps tip and stainless-steel plate until their surfaces were completely wet. After that, the bipolar forceps and stainless-steel plate were dried at room temperature for 10 min. We prepared the two different samples by controlling wettability: hydrophobic surface (sample 1), superhydrophobic (sample 2). The spraying distance was the same.


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Characterization. We investigated the surface morphology (stainless-steel plate with coating) by field emission scanning electron microscopy (Hitachi co., Ltd. Japan, S-4700, FE-SEM). Surface wettability was determined by measuring the contact angle with water, using a CCD camera device (OMRON SENTECH co., LTD. Japan, STC-MC33USB) and ImageJ (Version 1.50i; National Institutes of Health, Bethesda, MD, USA).

Adhesion force measurements. Electrosurgical instruments are usually made of a metal such as stainless steel. The tips of bipolar forceps are very narrow and it is difficult to evaluate adhesion force measurements. Therefore, we prepared a stainless-steel plate for adhesion force measurements. The adhesion force measurement machine (EZ-S, Shimadzu Co., Japan) with chicken meat and schematic diagram are shown in Figure 1. The size of the stainless-steel plate was 5 × 5 cm2. The size of the chicken meat was 1.5 × 2.5 cm2. The stainless-steel plate was put on the hot plate connected to a temperature controller (TR-KN, AS ONE Co., Japan) for increasing the surface temperature. After that, the temperature of surface was measured by an infrared thermometer camera (ARGO Co., Ltd. Japan, PI-450). The chicken meat made contact with the stainless-steel for 30 s.

3. RESULTS AND DISCUSSION Weight and temperature change of the bipolar forceps. We investigated the weight and temperature change of the forceps before and after they were used (contact with bipolar forceps and applied electricity) in 5 different areas. As shown in Figure 2, we compared bipolar forceps with and without a coating used in pig liver, chicken wing blood tube, chicken wing under the


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skin, chicken wing muscle, skin of the chicken wing. We measured the weight of the bipolar forceps before and after electricity was applied to the bipolar forceps. The weight change indicates the adsorption of various tissue (e.g., pig liver, chicken tissue) on the surface of the bipolar forceps. As shown in Figure 3, the bipolar forceps without a coating had a bigger difference in weight than that of the coated bipolar forceps. The temperature measurements (Figure 4, Figure S1) indicated that the average maximum temperature and increase in temperature was higher at the bipolar forceps without a coating. As shown in Figure 4e, there was only a slight difference in the average maximum temperature of the coated and uncoated bipolar forceps. This was because the thickness of the bipolar forceps tips that make contact with the sample was low (less than approximately 1 mm). Usually, the thickness of the bipolar forceps tips that make contact with the sample are from 2 to 5 mm. However, the thickness of chicken wing skin is approximately 1 mm (maximum thickness of limitation). However, other parts of a chicken wing are thicker than that of the skin. There was no significant difference in the weight and temperature of the bipolar forceps with and without a coating that made contact with pig liver. The pig liver has a lot of fat tissue distinct from the skeletal and smooth muscle. Therefore, the hydrophobic coating had a relatively small effect on the antiadhesion with oil media. This result indicated that the coating on the surface of the tip decreased the level of temperature increase. Accordingly, the decrease in the temperature rise and low difference in weight indicated that the hydrophobic coating reduced the adhesion of tissue.

Wettability analysis of surface. We measured the water contact angle of different surface coating samples. All the substrates were stainless-steel excepted meat. As shown in Figure 5, the water contact angle was approximately 0° (Meat), 73.1 ± 0.6° (without coating), 118 ± 0.6°


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(Sample 1), and 153.4 ± 0.6° (Sample 2). Sample 1 was fabricated by spraying 5 mL of hydrophobic silica on the surface followed by drying at room temperature. Sample 2 was fabricated by spraying 5 mL hydrophobic silica, followed by drying and spraying again with the same amount of hydrophobic silica (5 mL). Therefore, the stainless-steel surface in sample 2 had a much higher amount of hydrophobic silica.

Surface morphology of the coated sample. The surface morphology of the coated sample is shown in Figure 6. The major difference was the uniformity. SiO2 nanoparticles were not fully coated on Sample 1 (Figure 6a). However, SiO2 nanoparticle completely coated Sample 2 (Figure 6b). The difference in the contact angle measurements corresponded to the difference in the surface morphology. In the high-magnification images, we observed the SiO2 particles on the coated surface. There were no significant differences in the high-magnification images in Figure 6c and Figure 6d.

Adhesion force measurements. We investigated the adhesion force between the stainless-steel and the chicken meat. According to the result of the temperature measured by using an infrared thermometer camera (see Figure 4), we measured the adhesion force at different surface temperatures (60 °C, 80 °C, 100 °C). As shown in Figure 7, Sample 2 (superhydrophobic surface) had the lowest maximum applied force. The surfaces without a coating had the highest maximum applied force. This result showed that the adhesion force was the strongest on the surface without a coating. The increase in temperature of the meat was very rapid when the surface of stainless-steel did not have a coating. However, on the surface of sample 1


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(hydrophobic) and sample 2 (superhydrophobic), the increase in temperature of the meat was slower. This result showed that SiO2 played a role of heat insulation. The low increase in the temperature and low surface temperature had an effect on decreasing the adhesion force between the surface of the stainless- steel and meat sample. As a result, the hydrophobic and superhydrophobic surfaces displayed better antiadhesion than the surfaces without a coating. Among the modified surface, the superhydrophobic surface displayed the best antiadhesion properties.

Discussion and calculation of the adhesion forces between the coatings. The force of adhesion mediated by water depends on whether the water is pinned on the coating. Although the surface is superhydrophobic, the Cassie-Wenzel transition or Cassie-Wenzel mixed state by the adhesion pressure or heating can change the adhesion model to the following two types: 47

(i) In the case that the mediated water is pinned between the meat and the coating, as in Figure 8, the adhesion force (F ) is given by the sum of capillary forces (F ) and structural cohesion force of water (F ), which are given as Eq. (1) and Eq. (2):61 F = F + F = 2πγR + πγR (R

− R )

(1)

F = 2γπR

(2)

in which γ is the liquid-vapor interfacial tension, R is the radius of the liquid bridge neck, and R

is the meridional curvature of the meniscus surface. These forces are treated as a function of R and R

is decided by the apparent receding contact angle (θ ).


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Owing to the asymmetry of the meniscus curve between meat–water and coating–water, F is written as Eq. (3): "

F = !F + F ! − |F | = |πγR (2 − |∆R

|)| = πγR !2 − |sum(cosθ H)|!

(3) in which H is the distance between the liquid bridge neck and bottom. By measuring R , θ , and H, the adhesion force can be estimated. However, in this case, especially when the mediated liquid is a non-Newtonian fluid, the radius of the liquid bridge neck must be much larger than the distance between the liquid bridge neck and the bottom (i.e., R ≫ H~0).62 Thus, the adhesion force is almost the same regardless of the receding contact angle of water, according to the following Eq. (4): F ~2πγR

(4)

(ii) In the case that the mediated water is pinned on the meat but not adhered on the coating, as in Figure 9, the cohesion force is higher than the adhesion force on the coating, the adhesion force is simply given by the Young-Dupré equation:63 F = πr γ(1 + cosθ , )

(5)

in which r is the adhesion radius between the coating and water. In this case, F is much smaller than F . Thus, the adhesion force is strongly influenced by the receding contact angle of water as well as the liquid surface tension when the coating prevents the adhesion of water.


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As explained by the 2 cases above, adhesion of the meat mediated by water is decided by the Cassie or Wenzel state. In addition, these force analyses can be applied to the microscopic view. Thus, the adhesion force on the surface is written as Eq. (6): F = (1 − 234 )2πγR + 234 πr γ51 + cosθ , 6

(6)

in which 234 is the area fraction of the Cassie state hydrophobic coating. The surface tensions and contact angle values are functions of temperature, pressure, and free energy as intensive properties. In our equations, a liquid-vapor interfacial tension and an apparent receding contact angle are the intensive factors determined by temperature. Here, on the hydrophobic coating area, the adhesion radius is quite small and (1 + cosθ , ) is close to “0” when the area is strongly hydrophobic, as in Figure 5b, which is available both in room and high temperature in that the angle in high temperature should be smaller than room temperature. Hence, the adhesion force of the hydrophobic coating can be approximated to the following Eq. (7): F = (1 − 234 )2πγR

(7)

"7 Also, the maximum adhesion force F is expressed as Eq. (8): "7 F = (1 − 234 )2πγ(R89 ) (8)

in which R89 is the maximum value of R , which should be the initial radius of the liquid bridge neck (t=0: time to start peeling). In the case of the superhydrophobic coating (sample 2), some of the coating area is in the Wenzel state but the other is in the Cassie state owing to the non-uniform pressure exerted by the meat.


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"7 Thus, the F was not almost “0” owing to the partially Wenzel state. The strength of "7 F decreased in the order uncoated>sample 1>sample 2 (see Figure 7), which is "7 reasonable because the F decreases as the hydrophobic coating area increases (see Figure

5a for wettability and Figure 6 for hydrophobic coating area fraction). In this case, the uncoated surface is treated as 234 = 0. The reason why the adhesion force depends on the temperature is owing to the decrease of 234 rather than the change in γ. When the temperature increases, the vapor from the heated water as well as temperature gradient force between the water and coating converts the coating to the Wenzel state. Thus, the 234

"7 decreases to increase F , whereas the decrease of γ by increasing water temperature "7 decreases F . Therefore, the design of a uniform superhydrophobic coating area that

fulfills case (i) is a promising approach to design weak adhesion coating devices mediated by water.

4. Conclusion We investigated the difference in the wettability control of the surfaces of bipolar forceps by coating the surfaces with a hydrophobic coating and the effect of the coating on the mass of adhesion tissue and surface temperature. The coated bipolar forceps had a lower weight of adhesion tissue and lower increase in temperature than that of the uncoated bipolar forceps. A SiO2 thin film could reduce the temperature increase and hinder the adhesion of tissue. Because of the difference in the SiO2 coating uniformity, the surface wettability was changed from hydrophobic to superhydrophobic. A uniform surface structure with a SiO2 coating (superhydrophobic) showed low tissue adhesion on the surface. We also investigated the


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adhesion force at different surface temperatures. The hydrophobic and superhydrophobic surfaces showed better antiadhesion than the surfaces without a coating. Especially, the superhydrophobic surface showed the best antiadhesion properties in high-temperature conditions. Wettability control using a hydrophobic and superhydrophobic surface could be used to reduce or prevent the adhesion of tissue to medical equipment, which is needed for quick cleaning of the equipment.


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FIGURES

Figure 1. (a) Image of the adhesion force measurement machine with chicken meat. (b) schematic diagram of the adhesion force measurement machine. The stainless-steel substrate was placed on the hot plate. The hot plate was connected to a temperature controller and thermocouple. The meat sample was connected to the clip. After that, the meat sample was balanced at the center of stainless-steel substrate. In order to remove the pre-tension effect, we set the same distance with stainless-steel substrate and chicken meat and “0” point adjustment of applied force indicator before starting measurement.


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Figure 1. Images of bipolar forceps making contact with the 5 different areas. (a) pig liver (14 W), (b) chicken wing blood tube (7.2 W), (c) chicken wing under the skin (7.2 W), (d) Chicken wing muscle (7.2 W), (e) Chicken wing skin (7.2 W). Applied electricity (Watt) and current time were different. White scale bar is 2 cm.


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Figure 3. Weight change of bipolar forceps before and after use in the 5 different areas. (a) Pig liver, (b) chicken wing blood tube, (c) chicken wing under the skin, (d) chicken wing muscle, (e) chicken wing skin. We measured the weight of the bipolar forceps 3 times using a microbalance. After the bipolar forceps made contact with the 5 different areas, we confirmed the weight change of the bipolar forceps using the same procedure.


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Figure 4. Maximum temperature and temperature increase rate of bipolar tips with the 5 different areas. (a) Pig liver, (b) chicken wing blood tube, (c) chicken wing under the skin, (d) chicken wing muscle, (e) chicken wing skin. We measured the temperature surface of the sample which was contacted near the bipolar tips. We calculated temperature increasing rate ((maximum temperature − initial temperature) / time).


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Figure 5. Wettability analysis of different samples. (a) Contact angle and receding contact angle measurements on the surface of all the samples. Sample 1 was fabricated by spraying 5 mL hydrophobic silica on the surface followed by drying at room temperature. Sample 2 was fabricated by spraying hydrophobic silica 5 mL followed by drying and spraying again with the same amount of hydrophobic silica (5 mL); (b) Time-lapse photographs of a water droplet bouncing on the surface of sample 2.


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Figure 6. Field emission scanning electron microscopy images of (a) (c) sample 1, (b) (d) sample 2. (c) and (d) show the high-magnification images of the coated surface


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Figure 7. The adhesion force measurements with different surface temperature and maps of surface temperature. (a) 60 °C, (b) 80 °C, (c) 100 °C. The figures on the left shown the maximum applied force on different modified surfaces at the same surface temperature. The figures on the right show the maps of the surface temperature obtained by an infrared thermometer camera. In area 1, the white number indicates the surface temperature.


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Figure 8. Schematic illustration of the adhesion force analysis in the case that both the coating and meat are pinning the mediated water.


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Figure 9. Schematic illustration of the adhesion force analysis in the case that the mediated water is pinned on meat but not adhered on the coating


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ASSOCIATED CONTENT Supporting Information. The temperature curve of bipolar forceps making contact with different areas of the samples (coating and without coating): pig liver, chicken wing blood tube, chicken wing under skin, chicken wing muscle, chicken wing skin. The Supporting Information is available free of charge on the ACS Publications website or from the author.

AUTHOR INFORMATION Corresponding Author * Correspondence to: [email protected] Author Contributions S.S., J.M., J.P., and M.T. designed the experiments. J.M., J.P., M.T. conducted the experiment. J.P. and M.T analyzed the data. J.P. wrote the paper. S.S. provided scientific advices, commented on the manuscript, and supervised the project. All authors have given approval to the final version of the manuscript. Notes The authors declare no competing financial interest.

ACKNOWLEDGMENT We are grateful to Dr. Kyu-Hong Kyung whose comments and suggestions were greatly valuable throughout our study, and Dr. Kouji Fujimoto who gave us the advice of writing this article. We are indebted to Dr. Yoshio Hotta, whose relevant comments were an enormous help. A part of this work was supported by JSPS Kakenhi Grant Number JP17K04992, 1997.


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For Table of Contents Use Only

Antiadhesion Function between a Biological Surface and a Metallic Device Interface at High Temperature by Wettability Control Jun-Yong Park1, Mizuki Tenjimbayashi1, Jun Muto2, Seimei Shiratori 1, * 1.

Center for Material Design Science, School of Integrated Design Engineering, Keio University, 3-14-1 Hiyoshi, Yokohama, 223-8522, Japan.

2.

Department of Neurosurgical Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

Corresponding Author: [email protected]


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Antiadhesion Function between a Biological Surface and a Metallic

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