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18 May 2019, Volume 23 Issue 14 Previous Issue    Next Issue

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Antibiotic artificial bone implantation for treating pyogenic spondylodiscitis Yao Liquan, Ling Qinjie, Li Jiaying, Zhong Letian, Zhou Xingping, Liu Jintao, He Erxing, Yin Zhixun 2019, 23 (14):  2133-2139.  doi: 10.3969/j.issn.2095-4344.1662 Abstract ( 23 )   PDF (803KB) ( 83 )   Save BACKGROUND: There is no report on the treatment of suppurative discitis with posterior microendoscopic discectomy, antibiotic artificial bone implantation and one-stage percutaneous pedicle screw fixation. OBJECTIVE: To evaluate the clinical effectiveness of posterior microendoscopic debridement, antibiotic artificial bone implantation and one-stage percutaneous pedicle screw fixation for pyogenic spondylodiscitis. METHODS: Thirty-one patients with suppurative discitis admitted at the Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou Medical University from January 2014 to December 2017, including 17 males and 14 females, aged 28-78 years, were included. All the patients underwent posterior microendoscopic lesion clearance and antibiotic artificial bone grafting and one-stage percutaneous pedicle screw fixation. The erythrocyte sedimentation rate and C-reactive protein levels were detected at postoperative follow-up. The Visual Analog Scale and the Japanese Orthopaedic Association scores were used for detection. RESULTS AND CONCLUSION: (1) All the surgical operations of the 31 patients were successfully completed and all patients had immediate relief of low back pain and lower extremity radiation pain. They were able to move ground wearing a waistband at 1-4 days postoperatively. (2) Thirty-one patients were followed up for 9-18 months. All patients had a significant decrease in C-reactive protein and erythrocyte sedimentation rate at 1 week after surgery, and C-reactive protein and erythrocyte sedimentation rate were in the normal range at 1, 3, and 6 months postoperatively. (3) The Visual Analog Scale scores of all patients at 1 week of follow-up were significantly lower than those before surgery (P < 0.05), and the Japanese Orthopaedic Association scores were significantly higher than those before surgery (P < 0.05). (4) In the follow-up examination of CT and MRI, there was no recurrence, pseudoarticular formation or internal fixation loosening. (5) These results suggest that posterior microendoscopic discectomy, antibiotic artificial bone implantation combined with one-stage percutaneous pedicle screw fixation for treating suppurative discitis can result in little trauma, few bleeding and rapid pain relief, and patients can move to the ground early. The operation method has a good clinical effect. Figures and Tables | References | Related Articles | Metrics

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Kyphoplasty with bone cement injection for the treatment of osteoporotic vertebral compression fractures in different parts of the spine Zhang Lei, Wang Lingjun, Yang Huilin, Chen Liang, Gu Yong 2019, 23 (14):  2140-2146.  doi: 10.3969/j.issn.2095-4344.1633 Abstract ( 27 )   PDF (718KB) ( 89 )   Save BACKGROUND: Kyphoplasty with bone cement injection for the treatment of osteoporotic vertebral compression fractures has a good clinical effect, but it is unclear whether there is a difference in the efficacy on the fractures in different parts of the spine. OBJECTIVE: To compare the outcomes of kyphoplasty with bone cement injection in the treatment of osteoporotic vertebral compression fractures in different parts of the spine. METHODS: We retrospectively analyzed the clinical data of 247 cases of single-segmental osteoporotic vertebral compression fractures undergoing kyphoplasty with bone cement injection at the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University in China from January 2011 to August 2014. There were 24 cases of upper and middle thoracic (T1-T10) fractures, 187 cases of thoracolumbar (T11-L2) fractures and 36 cases of lower lumbar (L3-L5) fractures. The surgical time, X-ray exposure time, bone cement volume and leakage, the Visual Analog Scale score, the Oswestry Disability Index score, anterior vertebral height ratio and Cobb angle were assessed preoperatively, at 1 day posteroperatively and at the final visit. RESULTS AND CONCLUSION: (1) All patients underwent the surgery successfully, and were followed up for 12-44 months, with an average of (25.44±7.85) months. (2) There were 18 cases of bone cement leakage in the three groups, including 3 (12.5%) cases of upper and middle thoracic fractures, 13 (6.4%) cases of thoracolumbar fractures and 2 (5.6%) cases of lower lumbar fractures. (3) The surgical time and X-ray exposure time were significantly higher in the patients with upper and middle thoracic fractures than those with thoracolumbar fractures or lower lumbar fractures (P < 0.05), while the volume of bone cement was significantly lower than that in the other two groups (P < 0.05). Additionally, there were no significant differences in the surgical time, X-ray exposure time, and amount of bone cement between the patients with thoracolumbar fractures and with lower lumbar fractures (P > 0.05). (4) There were no significant differences in the Visual Analog Scale score, Oswestry Disability Index score, anterior vertebral height ratio and Cobb angle among the three groups preoperatively, at 1 day postoperatively and at the final visit (all P > 0.05). However, compared with baseline, these indicators were significantly improved in each group at 1 day postoperatively and at the final visit (P < 0.05). (5) To conclude, kyphoplasty with bone cement injection has achieved satisfactory outcomes in the treatment of osteoporotic vertebral compression fractures in different parts of the spine. Figures and Tables | References | Related Articles | Metrics

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Preparation and characterization of sustained-release levofloxacin bone tissue-engineered three-dimensional silk fibroin/chitosan/nano-hydroxyapatite scaffold Ye Peng, Luo Fuli, Liu Anping, Duan Haizhen, Hu Quan, Huang Wenjin, Cheng Yun, Yu Anyong 2019, 23 (14):  2147-2155.  doi: 10.3969/j.issn.2095-4344.1672 Abstract ( 17 )   PDF (1172KB) ( 81 )   Save BACKGROUND: Preliminary study has prepared the three-dimensional silk fibroin/chitosan/nano-hydroxyapatite scaffold successfully. OBJECTIVE: To explore the mechanical properties, physical characteristics, chemical composition and antibiotic sustained-release ability of three-dimensional silk fibroin/chitosan/nano-hydroxyapatite scaffold loaded with levofloxacin. METHODS: Levofloxacin/chitosan (3:1) microspheres were constructed by emulsion settlement filter method. 5, 7.5 and 10 g of microspheres were added into 2% of silk fibroin/chitosan/nano-hydroxyapatite mixed solution through freeze drying and chemical cross-linking to obtain the scaffolds loaded with antibiotics. The scaffolds loaded with antibiotics underwent scanning electron microscope observation, and chemical composition analysis. The sustained release, mechanical properties, porosity, water absorption expansion rate and hot water soluble loss rate were detected. RESULTS AND CONCLUSION: (1) Scanning electron microscope observed that there were drug microspheres at the inner wall of the scaffold, and the voidage was decreased with mass of microspheres increasing. (2) Energy spectrum analysis showed that the three kinds of scaffolds were rich in calcium and phosphonium ions. (3) The three kinds of scaffolds showed the same releasing trend, which presented with sudden-release effect at the former 3 days (release > 50%), and then tended to be stable. The release rate was the slowest in the scaffold loaded with 10 g of microscopes, and the rapidest in the scaffold loaded with 5 g of microscopes. (4) With the mass of microspheres increasing, there was an increase in the compressive and tension abilities and hot water soluble loss rate, and a decrease in the porosity, mean pore size and water absorption expansion rate. (5) These results indicate that the three-dimensional tissue-engineered scaffold loaded with levofloxacin is constructed successfully by freeze drying and chemical cross-linking method, which holds good sustained-release effect and compressive ability, water absorption expansion rate and hot water soluble loss rate. Figures and Tables | References | Related Articles | Metrics

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Calcium phosphate cement/fibrin glue composite loaded with recombinant human bone morphogenetic protein 2 promotes osteoporotic fracture healing Li Haoliang, Wang Xibin, Zuo Ruiting 2019, 23 (14):  2156-2161.  doi: 10.3969/j.issn.2095-4344.1665 Abstract ( 34 )   PDF (736KB) ( 71 )   Save BACKGROUND: Bone morphogenetic protein 2 is a most widely studied and osteogenic-inducing bone morphogenetic protein. However, simple bone morphogenetic protein can be diluted by tissue fluid and decomposed by protease after implantation, so it is difficult to maintain sustained drug concentration or play an effective role in bone induction. OBJECTIVE: To observe the effect of repairing osteoporotic fracture through calcium phosphate cement/fibrin glue composite as the carrier of bone morphogenetic protein 2. METHODS: Fifty-four female Sprague-Dawley rats were selected to remove bilateral ovaries for making osteoporosis models. Three months later, the middle femoral fracture models were made, and then randomized into three groups, with 18 rats in each group. Kirschner wire fixation group was injected nothing. The fracture end was injected with 0.5 mL calcium phosphate cement/fibrin glue (composite group) or calcium phosphate cement/fibrin glue loaded with recombinant human bone morphogenetic protein 2 (loaded group). At 4 and 12 weeks after fracture, X-ray examination, micro-CT examination, biomechanical three-point bending test and pathological observation were performed. RESULTS AND CONCLUSION: (1) The fracture healing score in the loaded group was higher than that in the other two groups (P < 0.05). (2) The bone volume fraction, trabecular thickness and number of trabeculae at 4 and 12 weeks in the loaded group were higher than those in the other two groups (P < 0.05), and the trabecular segregation was lower than that in the other two groups (P < 0.05). (3) The maximum load and stiffness at 4 and 12 weeks in the loaded group were higher than those in the other two groups (P < 0.05), and the elastic modulus at 4 weeks after fracture was higher than that in the other two groups (P < 0.05). (4) Fibrocartilage callus was mainly seen at 4 weeks after fracture in the Kirschner wire fixation group, and the callus was reconstructed into lamellar bone at 12 weeks after fracture with less callus content. Obvious fibrocartilage callus appeared at 4 weeks after fracture in the composite and loaded groups, and the callus was reconstituted into a plate-like bone at 12 weeks. (5) These results imply that the calcium phosphate cement/fibrin glue composite loaded with recombinant human bone morphogenetic protein 2 can promote the healing of osteoporotic fracture and improve bone strength. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional printing beta-tricalcium phosphate scaffold loaded with icariin particles for repairing osteonecrosis of the femoral head in rabbits Peng Chenjian, Du Bin, Sun Guangquan, Liu Xin, Xue Peng, Cao Liangquan 2019, 23 (14):  2162-2168.  doi: 10.3969/j.issn.2095-4344.1673 Abstract ( 458 )   PDF (829KB) ( 222 )   Save BACKGROUND: Preliminary study has prepared three-dimensional printing β-tricalcium phosphate scaffold loaded with icariin. OBJECTIVE: To investigate the role of three-dimensional printing β-tricalcium phosphate scaffold loaded with icariin in the repair of rabbit models of osteonecrosis of the femoral head. METHODS: New Zealand white rabbits (provided by Qinglongshan Laboratory Animal Center of Nanjing) were selected to establish the steroid-induced osteonecrosis of the femoral head. The 27 model rabbits underwent core decompression and debridement, were randomly divided into three groups, and then implanted with autologous bone, β-tricalcium phosphate scaffold, three-dimensional printing β-tricalcium phosphate scaffold loaded with icariin (composite scaffold group), respectively. The micro-CT scanning and pathological observation were performed at 4, 8, and 12 weeks after implantation. RESULTS AND CONCLUSION: (1) Micro-CT showed that at 4 weeks after implantation, trabecular bone was observed around and in implants in each group. In the autologous bone group, there were a large number of trabecular bones in the grafting area at 8 weeks, and the trabecular bone structure was dense at 12 weeks after implantation. In the tricalcium phosphate and composite scaffold groups, the scaffolds were well integrated with the bone interface. At 4 weeks after implantation, there was a certain amount of trabecular bone surrounding the scaffold, and trabecular grew into the scaffold until 8 weeks in the composite scaffold group. At 4 weeks after implantation, few thin trabecular bone was visible, and extensive trabecular bone formation was observed around the scaffold at 8 weeks in the tricalcium phosphate group. (2) Hematoxylin-eosin staining results showed that there were many mature osteoblasts, and few cartilage matrix, newly born bones integrated well to the implants at 12 weeks in the autologous bone and tricalcium phosphate groups. In the composite scaffold group, there were many cartilage matrixes, and newly born bones integrated poorly to the implants. (3) Masson staining showed that at 12 weeks after implantation, the osteogenic capacity in the composite scaffold group was lower than that in the autologous bone group (P < 0.05), but higher than that in the tricalcium phosphate group (P < 0.05). (4) TRAP staining results at 12 weeks after implantation revealed that the amount of osteoclast in composite scaffold group was less than that in the tricalcium phosphate group (P < 0.05), and was not significantly different from the autologous bone group (P > 0.05). (5) Immunohistochemical staining at 12 weeks after implantation revealed that the positive rate of vascular endothelial growth factor in the composite scaffold group was higher than that in the tricalcium phosphate group (P < 0.05), and lower than that in the autologous bone group (P < 0.05). (6) In summary, three-dimensional printing β-tricalcium phosphate scaffold loaded with icariin implanted into the rabbit model of osteonecrosis of the femoral head can promote the proliferation and differentiation of osteoblasts, inhibit the viability of osteoclasts, promote the angiogenesis, and contribute to the repair of osteonecrosis of the femoral head in rabbits. Figures and Tables | References | Related Articles | Metrics

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Type I collagen combined titanium dioxide nanotube composite coating modified titanium surface improves osteoblast adhesion and osseointegration Li Ying, You Yapeng, Li Baoe, Song Yunjia, Ma Aobo, Chen Bo, Han Wen, Li Changyi 2019, 23 (14):  2169-2176.  doi: 10.3969/j.issn.2095-4344.1669 Abstract ( 24 )   PDF (1069KB) ( 90 )   Save BACKGROUND: Simple nanotube surface modification of titanium implant has been shown to promote adhesion, proliferation and differentiation of osteoblasts. Collagen coating can promote osteoblast adhesion and osseointegration in vivo. OBJECTIVE: To observe the effects of type I collagen combined titanium dioxide nanotube composite coating modified titanium surface on osteoblast adhesion in vitro and osseointegration in vivo. METHODS: The titanium dioxide nanotube was fabricated on the pure titanium surface, then type I collagen was combined with the nanotube structure to form composite coating. Scanning electron microscope observation was used to characterize the surface topography of the pure titanium, titanium dioxide nanotube and type I collagen combined titanium dioxide nanotube surfaces. Contact angle test was employed to evaluate the hydrophilicity of different samples. MC3T3-E1 murine preosteoblasts were seeded on the three kinds of materials for 4 hours. Cell adhesion morphology was examined by scanning electron microscope. Adherent cell counting was detected under inverted fluorescence microscope. Expression of actin cytoskeleton and vinculin was observed under laser scanning confocal microscope. The gene expression of vinculin and osteoprotegerin mRNA was detected by real-time quantitative PCR. The three kinds of samples were implanted into the tibia of Sprague-Dawley rats (provided by Laboratory Animal Center, Institute of Radiation Medicine, Chinese Academy of Medical Sciences), and tibia samples were removed after 4 weeks of implantation for biological push-out test and histological observation. RESULTS AND CONCLUSION: (1) Scanning electron microscope: There was mechanical scratch on the pure titanium surface. There was controllable, and uniform vertical arrangement of nanotubular structures with a diameter of approximately 70 nm on the titanium dioxide nanotube surface, and collagen adhered surrounding the nanotubular structures on the type I collagen combined titanium dioxide nanotube substrate, and partial tubule orifices were closed. (2) The hydrophicility of type I collagen combined titanium dioxide nanotube was significantly larger than those of the other two materials (P < 0.05). (3) Compared with the pure titanium and titanium dioxide nanotube surfaces, the type I collagen combined titanium dioxide nanotube substrate displayed increased adherent cell number, much well-organized cytoskeleton, enhanced immunofluorescence intensity of vinculin protein staining, and increased expression levels of vinculin and osteoprotegerin mRNA levels (all P < 0.05). (4) In vivo test revealed that the maximum push-out force in the type I collagen combined titanium dioxide nanotube group was significantly higher than that in the pure titanium and titanium dioxide nanotube groups (P < 0.05). Hematoxylin-eosin staining results showed that there were few bones, but many fibrous connective tissue surrounding the implant in the pure titanium group; there were more newly-born bones, and less fibrous connective tissue surrounding the implant in the titanium dioxide nanotube group; there were dense newly-born bones, and few thin fibrous connective tissue surrounding the implant in the type I collagen combined titanium dioxide nanotube group. (5) These results indicate that type I collagen combined titanium dioxide nanotube surface can facilitate osteoblast cell adhesion and promote osseointegration in vivo. Figures and Tables | References | Related Articles | Metrics

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Autologous platelet gel-collagen biologically active composite membrane for repair of periodontal bone defect in rats Zhang Xufeng, Fu Qiya, Zheng Genjian, Guo Yusu, Chen Danyu, Fu Fangman, Wu Hui, Wang Lin 2019, 23 (14):  2177-2182.  doi: 10.3969/j.issn.2095-4344.1656 Abstract ( 16 )   PDF (836KB) ( 51 )   Save BACKGROUND: In recent years, the development of tissue engineering has provided a new approach for the treatment of periodontal bone defect. Tissue engineering therapy includes seed cells, scaffolds and growth factors. Platelet gel contains a large number of platelet growth factors, and collagen is often used for the preparation of scaffold materials. Therefore, the platelet gel and collagen biologically active composite membrane can provide scaffolds and growth factors for the defect bone. OBJECTIVE: To investigate the effect of autologous platelet gel-collagen biologically active composite membrane on the repair of periodontal bone defect in rats. METHODS: Forty-two Wistar rats (Shanghai Xipuer-Bikai Experimental Animal Co., Ltd., China) were selected. (1) Collagen was cut into 5 mm×2 mm size, and 10 mL of whole blood was extracted from 6 rats to obtain platelet-rich plasma. Autologous platelet gel-collagen composite membrane was prepared by adding bovine thrombin, calcium chloride and collagen in a certain proportion. Platelets in whole blood and in platelet-rich plasma were detected. The levels of platelet derived growth factor AB, transforming growth factor-β, basic fibroblast growth factor and vascular endothelial growth factor in whole blood and platelet-rich plasma were detected by ELISA. (2) The models of mandibular periosteal defect were established in 36 rats (the size of the bone defect was 5 mm×2 mm, and the root surface cementum was removed), and randomly divided into two groups. Autologous platelet gel-collagen group placed the autologous platelet gel-collagen composite membrane in the bone defect, and the control group did not place any materials. The hematoxylin-eosin staining of periodontal tissues of rats in each group was analyzed at 2, 4 and 8 weeks after surgery. Rate of new born, new centumum formation, new alveolar bone formation, and new periodontal ligament tissue formation height were measured. The expression of bone morphogenetic protein-2 was detected by immunohistochemical staining. RESULTS AND CONCLUSION: (1) The mean platelet count in platelet-rich plasma was 4.78 times as high as the whole blood, indicating that the number of platelets increased significantly after prepared into platelet-rich plasma (P < 0.05). The levels of platelet derived growth factor AB, transforming growth factor-β, basic fibroblast growth factor and vascular endothelial growth factor in platelet-rich plasma were 3.10, 3.45, 7.17 and 5.45 times of the whole blood, respectively (P < 0.05). (2) The results of hematoxylin-eosin staining observed that the rate of new born, new centumum formation, new alveolar bone formation, and new periodontal ligament tissue formation height at 2 weeks in the autologous platelet gel-collagen group showed no significant difference from the control group (P > 0.05). At 4 and 8 weeks, all above indexes in the autologous platelet gel-collagen group were significantly higher than those in the control group (P < 0.05). (3) Results of immunohistochemical staining revealed that at 2 weeks, bone morphogenetic protein-2 in the autologous platelet gel-collagen group began to express, and the expression of bone morphogenetic protein-2 was highest at 4 weeks (P < 0.05), and the positive expression was weakened at 8 weeks (P > 0.05). (4) Our results clarify that autologous platelet gel-collagen bioactive composite membrane can significantly promote the regeneration of new tooth, which is associated with the expression of bone morphogenetic protein-2, and reduce the repair time after periodontal tissue defect. Figures and Tables | References | Related Articles | Metrics

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A three-dimensional finite element model of mesio-occluso-distal cavity zirconium dioxide inlay and its bonding interface: a stress analysis Feng Ming, Zhang Guomei, Hu Yang, Zhu Jun 2019, 23 (14):  2183-2189.  doi: 10.3969/j.issn.2095-4344.1650 Abstract ( 33 )   PDF (1787KB) ( 87 )   Save BACKGROUND: Zirconia inlays have good mechanical, biocompatible and aesthetic properties in the field of dental prosthodontics, but there is no consensus on the standards of zirconia inlays for clinical cavity design, dental preparation and selection of bonding materials. OBJECTIVE: To investigate the stress distribution and characteristics of the bonding interface, tooth and periodontal tissues of the zirconia inlay model after 3M RelyX Unicem or vario-link resin adhesive bonding. METHODS: Micro-CT was used to scan the right mandibular third molars. A three-dimensional finite element model of MOD zirconia inlay with different adhesives (3M RelyX Unicem resin binder, vario-link resin binder) and cavity types (2, 3, 4 mm in the depth of the joint cavity) was constructed by software Mimics, Goemagic Studio and NX 10.0. Using ANSYS Workbench mesh generation, the stress distribution of each model was analyzed after loading 10 N•mm torque, 45° 175 N, 90° 600 N. RESULTS AND CONCLUSION: (1) After loading 10 N•mm torque, the bonding agent equivalent stress and root surface equivalent stress of the model with 3 mm cavity depth were largest, so the stress on the bonding interface, crown and root was largest. (2) After loading 175 N at 45° lingual direction, the bonding interface of the model with 4 mm cavity depth undertook a higher stress. The stress values of the root and periodontal tissue of 3M RelyX Unicem resin bonding agent model with the same cavity depth were higher. (3) After loading 600 N at 90°, the root force of the model with 3 mm cavity depth was largest. The crown, root and periodontal tissue of the 3M RelyX Unicem resin bonding agent model with the same cavity depth undertook a higher stress. The bonding interface of the vario-link resin bonding agent model was under greater stress. (4) The regions of stress concentration areas included the bifurcation zone of the root, the inlay edge line, the roof of pulp chamber, the gingival wall, 1/3 mesial part of the buccal surface near the neck, and 1/3 mesial part of the lingual surface near the neck. (5) All these findings indicate that vario-link resin adhesive and 3M RelyX Unicem resin adhesive are suitable for the bonding of zirconia inlay, but the vario-link adhesive strength is larger and the bonding interface stress is larger. The factors such as cavity design, residual tooth tissue resistance, retention shape, and periodontal support should be considered comprehensively. The optimization of cavity design, tooth preparation, cushion bottom and high inlay should be adopted, in order to improve the long-term repair effect of zirconia inlay. However, further clinical trials are needed to verify the results of three-dimensional finite element model. Figures and Tables | References | Related Articles | Metrics

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Immunotoxicity of absorbable silk fibroin biofilm on rats Xu Xiaoling, Pan Wangping, Lü Xiaojun, Zhang Ju, Hu Yuanhua, He Kaiyong 2019, 23 (14):  2190-2195.  doi: 10.3969/j.issn.2095-4344.1667 Abstract ( 30 )   PDF (931KB) ( 46 )   Save BACKGROUND: Silk fibroin, the main component of silk fibroin biofilm, is a natural protein, but it is still a heterologous protein to the body. Its immunogenicity/toxicity is an important factor in determining the development prospects. OBJECTIVE: To evaluate the toxicity of absorbable silk fibroin biofilm and its degradation products on the rat immune system by muscle implantation experiments in rats. METHODS: Ten Wistar rats from Beijing Weitong Lihua Experimental Animal Technology Co., Ltd. were implanted with a long strip of 1 mm× 10 mm in the right gluteal muscle to observe the implant absorption and determine the implantation cycle. Seventy-two Wistar rats were assigned into control and experimental groups (n=36/group, 18 in either sexes). A long strip of 1 mm×10 mm was implanted into the rat right gluteal muscle in the experimental group, and the control group received no implantation. Some of the rats were taken for histological examination and calculate the organ/weight ratio, at 26 weeks postoperatively. The spleen lymphocyte proliferation ability, NK cell activity, cell classification of T lymphocytes, and levels of interleukin 2 and tumor necrosis factor α were detected. Another part of the animals was taken for macrophage phagocytosis of erythrocytes cell capacity and antibody producing cell count. RESULTS AND CONCLUSION: (1) Silk fibroin biofilm was completely absorbed after implanted into the rat muscle for 26 weeks. (2) In female or male Wistar rats, the immune organs in the experimental group showed no significant changes in the appearance, weight and histological examination. There were no significant differences in the hematological indexes (hemoglobin, red blood cell count, hematocrit, blood platelet count and white blood cell count and classification), spleen lymphocyte proliferation, NK cell activity, the ratio of T lymphocytes and their subpopulations, and the levels of interleukin 2 and tumor necrosis factor α had no significant differences between two groups (P > 0.05). (3) In female or male Wistar rats, the macrophage phagocytosis of chicken erythrocytes cell capacity and antibody producing cell count showed no significant differences between two groups (P > 0.05). (4) These results indicate that silk fibroin biofilm causes no immunosuppression or immunostimulation on immune organs, immune cells and immune molecules (cytokines) of rats. Figures and Tables | References | Related Articles | Metrics

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Antibacterial properties of biodegradable zinc alloys in vivo Xie Zhong, Yang Mingzhi, Xue Jingbo, Chen Yong, Peng Lijun, Cai Bin, Zhang Yangyang 2019, 23 (14):  2196-2201.  doi: 10.3969/j.issn.2095-4344.1664 Abstract ( 24 )   PDF (737KB) ( 60 )   Save BACKGROUND: Zinc, an inorganic antibacterial material, has a suitable degradation rate and good antibacterial property. Adding alloying elements can improve the mechanical properties and biocompatibility of the material, which is the development direction of novel medical biodegradable metal materials. There is still lack a comparable research on the antibacterial properties among zinc-based materials. OBJECTIVE: To investigate the antibacterial properties of pure zine and zinc-based alloys in vivo. METHODS: Eighty Sprague-Dawley rats, SPF grade, were randomized into two groups (n=40/group), and all rats were injected with Staphylococcus aureus or Escherichia coli solution to prepare infection models. Different materials (Zn, ZnAl, ZnSr, Zn3Mg, Zn3Ag, Zn3Ca and Zn4Cu; five rats for each material) were implanted into the medullary cavity of femur. The control group without any material was set. At 1, 4, 7 and 14 days after implantation, the changes of body temperature, white blood cell count, serum tumor necrosis factor α and serum zinc content in rats were detected. The secretions and tissues of the surgical site were collected to identify the bacterial species. RESULTS AND CONCLUSION: (1) The body temperature in all the rats was increased to different extents after bacterial infection, but the temperature of the rats implanted with zinc and zinc alloys was always lower than that in the control group at 7 and 14 days (P < 0.05). The temperature in the Zn3Ag group was significantly lower than that in the other groups at 7 and 14 days (P < 0.05). (2) The white blood cell count and tumor necrosis factor α level in the zinc and zinc alloys groups were significantly lower than those in the control group at 7 and 14 days after implantation (P < 0.05). The white blood cell count and tumor necrosis factor α level in the Zn3Ag group were significantly lower than those in the other groups (P < 0.05). (3) The serum zinc content in all groups has no significant difference (P > 0.05). (4) The bacterial culture results showed S.aureus (+) in the Staphylococcus aureus infection group and E.coli (+) in the Escherichia coli infection group. (5) To conclude, degradable zinc-based alloys exert marked antibacterial effects, and Zn3Ag alloys have the best antibacterial activity. Figures and Tables | References | Related Articles | Metrics

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Neurotrophin-3 modified hyaluronan-methylcellulose hydrogel promotes neurological function in rats with spinal cord injury He Zhijiang, Zhu Lei, Cheng Shixiang, Huang Kui, Chen Cao, Sun Minglin 2019, 23 (14):  2202-2207.  doi: 10.3969/j.issn.2095-4344.1640 Abstract ( 18 )   PDF (756KB) ( 57 )   Save BACKGROUND: Hyaluronan-methylcellulose hydrogel cannot only be conjugated with short peptide sequences and growth factors to achieve sustained release, but also has a role in blocking dural defects and reducing inflammation. It is an ideal biomaterial for the treatment of spinal cord injury. OBJECTIVE: To investigate the effect of neurotrophin-3 modified hyaluronan-methylcellulose (HAMC-NT-3) hydrogel on the recovery of neurological function in rats with spinal cord injury.  METHODS: Fifty-four female Sprague-Dawley rats (provided by the Experimental Animal Center of the Academy of Military Medical Sciences in China) were randomly divided into three groups (n=18 per group). The sham group only underwent T10 laminectomy. In the model group and the experimental group, an aneurysm clip was used to establish spinal cord injury models after T10 laminectomy. The experimental group was locally injected with HAMC-NT-3 hydrogel. The Basso Beattie Bresnahan function scoring was performed at 1 day, 1, 2, 3, 4, 5, 6, 7, and 8 weeks after surgery. The inclined plane test was performed at 4, 6 and 8 weeks after surgery to evaluate the recovery of hindlimb motor function. ELISA was used to detect the concentrations of inflammatory factors in the spinal cord at 1 week after surgery. Immunohistochemical staining was used to observe the area of syringomyelia, glial fibrillary acidic protein expression and nerve regeneration at 8 weeks after surgery.  RESULTS AND CONCLUSION: (1) The Basso Beattie Bresnahan scores of the model group and the experimental group were lower than those of the sham group at various time points after surgery (P < 0.05). The Basso Beattie Bresnahan scores of the experimental group were higher than those of the model group at 4-8 weeks after surgery (P < 0.05). (2) In the inclined plane test, the maximum inclined angles of the model group and the experimental group at each time point after surgery were lower than that of the sham group (P < 0.05). The maximum inclined angles of the experimental group at 6 and 8 weeks after surgery were higher than those of the sham group (P < 0.05). (3) The concentrations of tumor necrosis factor-α, interleukin-1β, interleukin-6 and interleukin-10 in the experimental group and the model group were higher than those in the sham group (P < 0.05). The concentrations of tumor necrosis factor-α, interleukin-1β and interleukin-6 in the experimental group were lower than those in the model group (P < 0.05). The concentration of interleukin-10 in the experimental group was higher than that in the model group (P < 0.05). (4) Immunohistochemical staining showed that the expression levels of glial fibrillary acidic protein in the experimental group and the model group were higher than those in the sham group, while the expression of glial fibrillary acidic protein in the experimental group was lower than that in the model group. The area of syringomyelia in the experimental group was smaller than that in the model group (P < 0.05). These results indicate that local injection of HAMC-NT-3 hydrogel can effectively inhibit inflammation as well as astrocyte activation and proliferation, reduce fibrous scar formation, and promote the protection of nerve tissue and the recovery of hindlimb motor function after spinal cord injury. Figures and Tables | References | Related Articles | Metrics

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Short-term efficacy evaluation of Mis Seven implant system repairing dentition loss Wang Liping, Chen Weihong, Zha Jun, Chen Xili, Su Yucheng, Fang Ying, Dong Yu, Guo Xueqi, Ge Linhu 2019, 23 (14):  2208-2214.  doi: 10.3969/j.issn.2095-4344.1668 Abstract ( 66 )   PDF (1267KB) ( 67 )   Save BACKGROUND: Mis Seven implant has become more and more popular in oral implant restoration, and the clinical application in dentate-deficient patients remains to be studied. OBJECTIVE: To explore the short-term effects of the Mis Seven implant system on fixed restorations in dentition loss. METHODS: Nineteen patients undergoing fixed dental prostheses with the Mis Seven system due to dentition loss at the Department of Implants of the Stomatological Hospital of Guangzhou Medical University between April 2015 and December 2017 were included. Three patients had missing maxillary and maxillary dentition and unilateral maxillary teeth. Six patients were loss of maxillary dentition, and there were 10 cases of unilateral mandibular dentition missing. The total dental implants were 134. All cases were implanted and fixed for one stage. Clinical examination, alveolar bone and inter-implant image performance and post-load repair effect at 6, 12 and 24 months of follow-up were used as evaluation indicators. RESULTS AND CONCLUSION: (1) In 134 implants, failure was in 2 cases due to surrounding tissue infection. The success rate of before implant restoration was 98.51%, and the success rate after repair was 100%. (2) The stability of dentition of 19 patients was good, showing good occlusion. No mechanical complications or biological complications occurred. The stability of the restoration was 100%. (3) The vertical absorption of bone tissue around all implants was less than 0.2 mm at 6, 12, 24 months after repair, suggesting that the implant has no obvious edge bone resorption. The gingival tissues around all implants were healthy, and no unhealed inflammation or hyperkeratosis appeared. (4) These results imply that the Mis Seven system in the dentition defect fixation exhibits good short-term clinical results. Figures and Tables | References | Related Articles | Metrics

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Physical properties and biocompatibility of 3D printed bone microparticle/poly(lactic-co-glycolic acid) scaffold Zhang Minbo, Peng Qifeng, Ma Yaping, Kong Weijun, Liao Wenbo 2019, 23 (14):  2215-2222.  doi: 10.3969/j.issn.2095-4344.1641 Abstract ( 30 )   PDF (1001KB) ( 62 )   Save BACKGROUND: 3D printing technology provides possibility for the preparation of an ideal bone tissue engineering scaffold with high individualization, precise regulation of the porosity, pore size and inter-aperture connectivity. OBJECTIVE: To study the physical properties and biocompatibility of allogeneic bone microparticle/poly(lactic-co-glycolic acid) composite absorbable scaffolds fabricated via fused deposition modeling 3D printing. METHODS: 3D printed bone microparticle/poly(lactic-co-glycolic acid) composite absorbable scaffolds were fabricated via fused deposition modeling. The porosity, water absorption, water contact angle and in vitro degradation rate of the scaffold were measured. (1) Cytotoxicity test: Rabbit adipose-derived mesenchymal stem cells were cultured in normal medium (negative control group) and composite scaffold extract (experimental group) for 1, 3, 5, 7 days, and cell counting kit-8 was then used to detect cell proliferation. (2) Hemolysis test: Rabbit anti-clotting was added to physiological saline, distilled water and composite scaffold extract, and the hemolysis rate was detected after 50 minutes. (3) Acute toxicity test: The physiological saline and composite scaffold extracts were intraperitoneally injected into the rabbits respectively to observe the general condition of rabbits and the pathological changes of important organs. RESULTS AND CONCLUSION: (1) The porosity, water absorption and water contact angle of the composite scaffold were (60.86±2.88)%, (53.98±2.04)% and (76.27±0.34)°, respectively. (2) After in vitro immersion in PBS for 4 weeks, the absorbable composite scaffold degraded relatively slowly, and the scaffold morphology remained stable, while the degradation rate accelerated after 4 weeks. The scaffold was almost completely absorbed at about 11 weeks, and it is a relatively ideal absorbable scaffold material. (3) There was no difference in cell proliferation between the experimental group and the negative control group at different time points (P > 0.05). The cytotoxicity of the absorbable composite scaffold was grade 1. (4) The hemolysis rate of the absorbable composite scaffold was 3.8%, which met the hemolytic requirement of biomedical materials (the hemolysis rate of less than 5%). (5) Within 72 hours after injection of absorbable scaffold extract, the rabbits showed no acute toxic reaction, as well as no pathological changes in the liver, heart and kidney were observed after 7 days of injection. (6) To conclude, the 3D printed allogeneic bone microparticle/poly(lactic-co-glycolic acid) fabricated via fused deposition modeling 3D printing has preferable physical properties and biocompatibility. Figures and Tables | References | Related Articles | Metrics

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Fabrication and biocompatibility assessment of the scaffold with biomimetic interconnected macropore structure Li Zhi, Tan Chunhua, Cai Xianhua, Wang Huasong, Ding Xiaoming, Zhao Yanhong 2019, 23 (14):  2223-2227.  doi: 10.3969/j.issn.2095-4344.1674 Abstract ( 12 )   PDF (711KB) ( 57 )   Save BACKGROUND: Development of bone tissue engineering provides a new method to solve bone defect repair. Scaffold material and structure construction are issues of concern. OBJECTIVE: To fabricate a silk fibroin and hydroxyapatite scaffold with biomimetic interconnected macropores structure using the paraffin-sphere leaching technology and to evaluate its possibility of cytocompatibility. METHODS: The scaffold with biomimetic interconnected macropores structure was made by the paraffin-sphere leaching technology. The structure of scaffold was observed by the stereomicroscope and scanning electron microscope. The pore size and elasticity modulus were calculated. Passage 3 rabbit adipose-derived mesenchymal stem cells were seeded into the scaffold. The cell viability was detected by live/dead staining at 48 hours after culture. The cell adhesion was observed by hematoxylin-eosin staining at 1 week of culture. The scaffold-cell composite was observed under scanning electron microscope at 3 days of culture. The cell proliferation was detected by the cell counting-kit 8 assay at 1, 3, 5 and 7 days of culture. Those cells cultured alone were considered as control group. RESULTS AND CONCLUSION: (1) Stereomicroscope showed the ivory silk fibroin/hydroxyapatite scaffold. Scanning electron microscope revealed pore structures in cross-section and longitudinal-section with good connectivity. The scaffold pore size was (362.23±26.52) μm and the elasticity modulus was (54.93±5.44) kPa. (2) Scanning electron microscope showed that adipose-derived mesenchymal stem cells adhered and stretched well in the pore wall and connected pore, secreted abundant extracellular matrix, and filled in the pores of silk fibroin/hydroxyapatite scaffold. (3) Hematoxylin-eosin staining results found that adipose-derived mesenchymal stem cells evenly adhered onto the inner wall of silk fibroin/hydroxyapatite scaffold, and proliferated well. (4) Live/dead staining revealed a good viability of adipose-derived mesenchymal stem cells. (5) Cell counting-kit 8 assay results showed the good proliferation of adipose-derived mesenchymal stem cells on the scaffold. (6) To conclude, the silk fibroin/hydroxyapatite scaffold possesses good pore size and cytocompatibility. Figures and Tables | References | Related Articles | Metrics

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Choosing appropriate lysis buffers for protein extraction from acidotic mouse skeletal muscles Luo Xuguang, Zang Haojing, Sun Peng, Cao Ximei 2019, 23 (14):  2228-2234.  doi: 10.3969/j.issn.2095-4344.1661 Abstract ( 440 )   PDF (769KB) ( 93 )   Save BACKGROUND: RIPA Buffer exhibits different extraction efficiencies of proteins of cells and tissues, which is not appropriate for all samples.  OBJECTIVE: To achieve an optimal lysis buffer for skeletal muscle protein extraction in mice of acidosis, and to provide basis for studies on skeletal muscle atrophy. METHEDS: Twenty male healthy C57BL/6 mice, aged 3 months, weighting 25-30 g, were provided by Laboratory Animal Center of Shanxi Medical University. The mice were sacrificed after anesthesia, and the gastrocnemius muscle of lower extremity was isolated. There were two groups: acidosis group was given 10 g of feed mixed with 0.4 mol/L hydrochloric acid (10 mL), and control group received 10 g of feed mixed with same volume of water, for 7 consecutive days. The effect of RIPA Buffer, Original Buffer and JP Buffer on the skeletal muscle protein extraction in mice of acidosis was compared. The expression levels of AKT, p-AKT (Thr308), rpS6 and p-rpS6 (Ser235/236) were detected by western blot assay. GLUT4 mRNA expression was examined by RT-qPCR. RESULTS AND CONCLUSION: (1) Different buffers generated different protein-yields. The protein yield was highest in JP Buffer, but the target protein signal was not high. The protein yield was low in RIPA Buffer. Original Buffer could extract sufficient proteins, and had clear band detected by western blot assay. (2) Western blot assay scores in Original Buffer were higher than those of other two buffers. (3) Western blot assay results showed that the extent of phosphorylation in both groups showed no significant changes. (4) GLUT4 mRNA expression level examined by RT-qPCR showed no significant changes in both groups. (5) These results indicate that Original Buffer is optimal lysate of skeletal muscle protein extraction. Inactivated AKT signaling pathway is seen in the short-term hydrochloric acid-induced acidosis group, so whether lengthening acidosis time can activate the signaling pathway. Selecting the optimal lysis buffer for different samples is premise to ensure western blot assay results.   Figures and Tables | References | Related Articles | Metrics

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Double plasma molecular adsorption combined with plasma exchange versus simple plasma exchange for the treatment of liver failure Wei Min, Peng Hong, Xiong Tingting, Du Zhichan, Luo Xinhua 2019, 23 (14):  2235-2240.  doi: 10.3969/j.issn.2095-4344.1655 Abstract ( 535 )   PDF (627KB) ( 92 )   Save BACKGROUND: Double plasma molecular adsorption system cannot only specifically absorb bilirubin and bile acids, but also eliminate toxins, inflammatory transmitters and cytokines in the body. In the absence of plasma or in the case of plasma deficiency, it can effectively remove harmful substances, prevent multiple organ failure and fight for time for the liver regeneration and recovery of liver function, which is suitable for liver failure caused by various reasons. OBJECTIVE: To compare the validity and safety of double plasma molecular adsorption system combined with plasma exchange and simple plasma exchange in the treatment of liver failure. METHODS: Sixty patients with liver failure admitted to the Guizhou Provincial People’s Hospital from October 2014 to October 2017 were included and randomized into two groups (n=30/group). Plasmapheresis was used in plasma exchange group, and the volume of plasma exchanged was 2 500-3 000 mL. The combination treatment group was treated by double plasma molecular adsorption system combined with plasma exchange, and the volume of plasma exchanged was 1 000-1 500 mL. In the two groups, the clinical effects and liver function were evaluated after three treatment sessions, and adverse reactions were observed during the artificial liver treatment. RESULTS AND CONCLUSION: After treatment, the levels of serum total bilirubin and alanine aminotransferase were significantly lower than those before treatment, and the prothrombin activity was significantly higher than that before treatment (P < 0.05). However, the serum albumin level showed no significant difference in the combination treatment group before and after treatment. Compared with the plasma exchange group, the post-treatment levels of serum total bilirubin, alanine aminotransferase and serum albumin were significantly lower in the combination treatment group, and the prothrombin activity was significantly higher (P < 0.05). (2) The total effective rate of the combination treatment group (83%) was significantly higher than that of the plasma exchange group (63%) (P < 0.05). (3) During the artificial liver treatment, there was one case of rash, one case of chills and one case of hypotension in the combination group, while no adverse reaction occurred in the plasma exchange group. (4) To conclude, either double plasma molecular adsorption combined with plasma exchange or simple plasma exchange can markedly improve the liver function of patients with liver failure, and produce few adverse reactions. However, the combination of double plasma molecular adsorption and plasma exchange has an advantageous therapeutic effect and can reduce plasma consumption. Figures and Tables | References | Related Articles | Metrics

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Nanomaterials applied in tumor imaging diagnosis and treatment: an integration tendency Chen Yue, Zhang Tianke, Xu Yong 2019, 23 (14):  2241-2247.  doi: 10.3969/j.issn.2095-4344.1666 Abstract ( 46 )   PDF (735KB) ( 71 )   Save BACKGROUND: With the rapid development of nano-technology, the research and application of nanomaterials in biomedicine are increasing due to various advantages. It becomes a promising research direction in new anti-tumor methods. OBJECTIVE: To summarize the application of nanomaterials in imaging diagnosis and treatment of tumors. METHODS: The authors retrieved articles about the application of nanomaterials in tumor imaging diagnosis and treatment in WanFang, VIP, Elsevier and PubMed databases. The keywords were “nanophase materials, imaging diagnosis of tumor, nanocarriers, treatment of tumors, biological toxicity” in Chinese and English, respectively. RESULTS AND CONCLUSION: Due to its unique physical and chemical properties and plasticity, nanomaterials can become targeted medical materials that can carry anti-tumor drugs or active factors through specific modifications. Moreover, nanomaterials can adapt to different demands through various modifications and structural changes. Therefore, they have an unlimited prospect in the medical field. Currently, nanomaterials are not independent in the aspects of tumor diagnosis and treatment, but show an integration trend; that is, they are first targeted to tumor tissues, release active drugs during imaging diagnosis, or kill tumors through photothermal transformation. Figures and Tables | References | Related Articles | Metrics

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Application and research of iron oxide nanoparticles in bone tissue repair Shen Mengjie, Yang Kun, Liu Qi 2019, 23 (14):  2248-2253.  doi: 10.3969/j.issn.2095-4344.1652 Abstract ( 9 )   PDF (675KB) ( 51 )   Save BACKGROUND: Iron oxide nanoparticles are a kind of magnetic nanomaterial. Their excellent characteristics make them more and more widely used in medicine, especially in bone tissue regeneration and repair. OBJECTIVE: To review the research progress and application of iron oxide nanoparticles in bone tissue repair and regeneration. METHODS: A computer-based search of CBM, CNKI, PubMed and Elsevier was performed for retrieving articles concerning iron oxide nanoparticles for bone tissue regeneration published from May 2004 to January 2018. The keywords were “bone repair; bone regeneration; iron oxide nanoparticles; magnetic nanoparticles” in Chinese and “IONPs; bone repair; bone regenerate; iron oxide nanoparticles; osteogenesis; stem cell” in English. RESULTS AND CONCLUSION: In recent years, magnetic nanoparticles have been widely used in medical research, such as targeted drug delivery, magnetic resonance imaging, local tissue thermotherapy and tumor therapy, biological separation and biological sensors. The magnetic nanoparticles commonly used at present are iron oxide nanoparticles. Studies have proven that iron oxide nanoparticles have a close relationship with stem cell homing, and they are able to carry drugs into a specific target area, promoting bone tissue regeneration and repair. Although initial results have been achieved in the research on iron oxide nanoparticles in promoting bone tissue repair, the mechanism by which iron oxide nanoparticles promote bone healing has not been fully elucidated, and most studies are only limited to basic research. Future basic and clinical studies on the mechanism of iron oxide nanoparticles in promoting bone tissue healing need to be strengthened. Figures and Tables | References | Related Articles | Metrics

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Antimicrobial modification for orthopedic metal implants: merits and demerits Luo Jin, Lan Hai 2019, 23 (14):  2254-2260.  doi: 10.3969/j.issn.2095-4344.1651 Abstract ( 10 )   PDF (748KB) ( 52 )   Save BACKGROUND: Infection of orthopedic implants is a problem to be solved. Currently, scholars are trying to endow orthopedic implants with an anti-infection function, and the research on antibacterial activity of implants has been a hot topic. OBJECTIVE: To introduce the modification methods of orthopedic metal implants in recent years. METHODS: Science Direct online (2015-2019), WanFang (2015-2018) and VIP (2015-2018) databases were retrieved for literatures using the keywords of “antimicrobial, coating” in English and Chinese, respectively. RESULTS AND CONCLUSION: The currently used antimicrobial modification for orthopedic implants mainly consists of the self-antibacterial modification of the implant and the antibacterial modification on the surface of the implant. The antibacterial modification methods on the surface of the implant mainly include electrochemical modification method, magnetron sputtering method, spraying method, chemical conversion method, laser surface modification method, plasma injection method, nanosphere photolithography, sol/gel method, hydrothermal method, layer-by-layer assembly and combined treatment of various methods. Each antimicrobial modification method has its own merits and demerits. Figures and Tables | References | Related Articles | Metrics

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Allogeneic and xenogeneic tissue repair materials: how to choose a suitable virus inactivation process Bai Yulong, Gao Yufeng, Zhong Hongbin, Zhao Yantao, Guo Ruizhou, Li Li 2019, 23 (14):  2261-2268.  Abstract ( 313 )   PDF (891KB) ( 133 )   Save BACKGROUND: A propervirus inactivation procedure of medical bio-derived tissue repair material is very important to reduce the risk of virus infection and ensure the safety in the therapeutic process. OBJECTIVE: To elaborate different virus inactivation methods of allogeneic and xenogeneic tissue repair materials. METHODS: PubMed, Elsevier, CNKI, and WanFang databases were searched for relevant articles using the keywords of “allogeneic, xenogeneic, viral inactivation, disinfection, tissue repair biomaterial” in English and Chinese, respectively. RESULTS AND CONCLUSION: Virus inactivation methods can damage the performance of biological materials to different extents. For example, heat inactivation may produce permanent damage to the performance of heat-sensitive materials; γ-ray irradiation may result in the loss of mechanical properties and biologically active substances; acid/alkali method may also destroy the properties and structure of some materials intolerant to acid and alkali corrosion; and some reagent residues such as ethylene oxide, peracetic acid, and hydrogen peroxide may produce irritation to the body and even cause carcinogenic and teratogenic substances. Therefore, in enterprises and research institutions, the virus-killing effect and severity of damage to the material performance should be considered when the virus inactivation process is selected, and the use of existing production processes to verify the virus inactivation is recommended as much as possible. Figures and Tables | References | Related Articles | Metrics

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Patent analysis for calcium phosphate bone cements Zhang Xiaodong, Liu Ying 2019, 23 (14):  2269-2278.  doi: 10.3969/j.issn.2095-4344.1615 Abstract ( 35 )   PDF (1113KB) ( 88 )   Save BACKGROUND: Calcium phosphate bone cement exhibits great commercial potential as bone filling materials in the field of clinical biomedical engineering; however, due to some existing technical and theoretical challenges, its wide spread application is hindered. It is therefore necessary to search existing patents to explore various potential improvements in modification of calcium phosphate bone cement. OBJECTIVE: To analyze the patent information of calcium phosphate bone cement for better understanding of the development of the calcium phosphate bone cement technology, and for early warning of patent infringement. METHODS: Based on the manual screening of Incopat patent database, we analyzed 2 711 patent documents from four aspects — the application trend, patent layout, competitor analysis, and efficacy matrix. In combination with technology development and industrialization, this paper also shows some important Chinese patents selectively. RESULTS AND CONCLUSION: The United States is in the leading position in the calcium phosphate bone cement field, while this technology is developing rapidly in China. Various components and methods are developed for modifying calcium phosphate bone cement, which are the focus of patent development and layout. Although some of the fundamental patents have expired, patent infringement risks need to be tested and mitigated for the development and industrialization by Chinese enterprises as there are some important patents in China arranged by foreign companies. At the same time, Chinese patent holders need to master international patent layout and develop their intellectual properties for the future international marketplace. Figures and Tables | References | Related Articles | Metrics

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Research progress of myocardial scaffolds in the treatment of myocardial infarction Zhao Liang, Qiu Xiaona, Li Xiafei 2019, 23 (14):  2279-2284.  doi: 10.3969/j.issn.2095-4344.1639 Abstract ( 23 )   PDF (680KB) ( 60 )   Save BACKGROUND: In recent years, myocardial tissue engineering has developed rapidly. By using exogenous biomaterials to simulate extracellular matrix, damaged myocardial cells can be effectively repaired or reconstructed, which has great potential value in the treatment of ischemic heart diseases such as myocardial infarction. OBJECTIVE: To review the research progress of myocardial scaffolds in the treatment of myocardial infarction. METHODS: NCBI and WanFang databases were retrieved for relevant articles published from 2008 to 2018, with the key words of “myocardial scaffold materials, myocardial infarction” in English and Chinese, respectively. RESULTS AND CONCLUSION: At present, the commonly used myocardial scaffolds are mainly natural biomaterials (including collagen/ Matrigel, fibrin, chitosan, hyaluronic acid, and algae hydrochloric acid), synthetic materials (polyester synthetic materials and nanomaterials) and composite scaffolds. Due to the complexity of cardiac environment and heart function, the selection of scaffold materials should fully take account of biocompatibility, immunogenicity, conductivity, degradation rate and susceptibility to ischemia and hypoxia. Although many scaffold designs have begun to meet many requirements, there are still many kinds of stent materials for clinical application. It is believed that with the further development of researchers and application tools, people can expect to create myocardial scaffolds close to the physiological function of the original tissue, so that the heart function can be better restored. Figures and Tables | References | Related Articles | Metrics

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Efficacy and safety of platelet-rich plasma in the treatment of diabetic foot ulcer: a meta-analysis Niu Caili, Huang Ruina, Xu Ziqi, Lu Yongmei, Huang Yongming, Zeng Xiuyun 2019, 23 (14):  2285-2291.  doi: 10.3969/j.issn.2095-4344.1663 Abstract ( 27 )   PDF (704KB) ( 80 )   Save BACKGROUND: Platelet-rich plasma has been used in the treatment of wounds in orthopedics, burn and plastic surgery, and has achieved good results. But its therapeutic effect in diabetic foot ulcers is still controversial. OBJECTIVE: To systematically evaluate the efficacy and safety of platelet-rich plasma in diabetic foot ulcer. METHODS: PubMed, EMbase, The Cochrane Library, CBM, CNKI, and VIP databases were searched for a randomized controlled trial of platelet-rich plasma for treating diabetic foot ulcers published before September 2018. Meta-analysis was performed using RevMan 5.3 software after two investigators independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. RESULTS AND CONCLUSION: (1) Sixteen randomized controlled trials were included, including 925 patients. The trial group was treated with platelet-rich plasma alone or platelet-rich plasma combined with conventional therapy (debridement, vacuum sealing drainage, or dressing coverage). The control group received routine treatment, blank control or placebo treatment. (2) Meta-analysis showed that the healing rate in the trial group was higher than that in the control group [OR=3.05, 95%CI (2.25, 4.13), P < 0.000 01]; effective rate was higher than that in the control group [OR=3.84, 95%CI (2.44, 6.06), P < 0.000 01]; the ulcer healing time was shorter than that in the control group [MD=-11.39, 95%CI (-13.45, -9.34), P < 0.000 01]; the cost of treatment was lower than that in the control group [MD=-5 927.76, 95%CI (-10 413.04, -1 442.49), P=0.010]; and the hospitalization time was less than that in the control group [MD=-14.77, 95%CI (-18.82, -10.73), P < 0.000 01]. (3) Four studies reported adverse reactions, but adverse reactions were not associated with platelet-rich plasma. (4) These results suggest that platelet-rich plasma has a good clinical effect in promoting the healing of diabetic foot ulcers, and no adverse reactions occur. Due to limitations in the quantity and quality of the studies, the above conclusions are yet to be verified by more high-quality studies. Figures and Tables | References | Related Articles | Metrics

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Effects of five different dressings in the treatment of donor site: a network meta-analysis Qiu Wenbo, Wu Xiaowan, Han Hui, Huang Ruina, Chen Huichao 2019, 23 (14):  2292-2296.  doi: 10.3969/j.issn.2095-4344.1657 Abstract ( 32 )   PDF (612KB) ( 55 )   Save BACKGROUND: At present, there is no consensus on the effect of different dressings in the healing of donor site, and few studies have directly compared the healing effect of different dressings. OBJECTIVE: To evaluate the healing effect of five different dressings on donor site wounds by network meta-analysis. METHODS: Randomized controlled trials about different dressings in the treatment of donor site wounds were retrieved by computer in PubMed, EMBASE, Cochrane, Chinese Academic Journal Full Text Database, Chinese Biomedical Literature CD-ROM Database, WanFang Data Platform and Chinese Science and Technology Journal Database. The retrieval time limit was from inception until May 2018. Literature screening, quality evaluation and data extraction were conducted independently by two postgraduates. Winbugs 1.4.3 and Stata 13.0 softwares were used for data analysis. RESULTS AND CONCLUSION: A total of 13 randomized controlled trials were included. In the observation group, foam dressing, hydrocolloid dressing, alginate dressing or silver dressing was used. In the control group, vaseline gauze was used. The results of network meta-analysis showed that the healing time of donor sites for alginate dressing, silver dressing, hydrocolloid dressing and foam dressing was significantly shorter than that of vaseline gauze (P < 0.05), but there was no difference in wound healing time between foam dressing, hydrocolloid dressing, alginate dressing and silver dressing at the donor site (P > 0.05). The healing effects of different dressings were ranked as follows (from good to bad): alginate dressing, silver dressing, hydrocolloid dressing, foam dressing and vaseline gauze. Overall findings indicate that alginate dressing may be the best choice to shorten the healing time of donor site, and further investigations are warranted. Figures and Tables | References | Related Articles | Metrics