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    08 October 2020, Volume 24 Issue 28 Previous Issue    Next Issue
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    Different material factors affect the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells
    Wang Yanghao, Wang Weizhou, Duan Hao, Zhong Zongyu, Li Xiaozhuang, Tang Zhihong, He Fei
    2020, 24 (28):  4429-4436.  doi: 10.3969/j.issn.2095-4344.2315
    Abstract ( 384 )   PDF (48303KB) ( 31 )   Save

    BACKGROUND: In the treatment of bone defect or bone injury by tissue engineering, biomaterials affect the survival rate, proliferation and differentiation of bone marrow mesenchymal stem cells.

    OBJECTIVE: To review the research progress regarding how biomaterials affect the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells, and to guide the rational application of biomaterials.

    METHODS: A computer-based online search of CNKI, PubMed, Web of Science, and Wanfang database with the search terms “Bone marrow mesenchymal stem cells, Osteogenic differentiation, Biological materials, The microstructure". The eligible literatures regarding the effects of different biomaterials on the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells were included.  

    RESULTS AND CONCLUSION: (1) Metallic materials have the advantages of good biocompatibility, bone conductivity, and mechanical performance. Non-metallic materials exhibit good biocompatibility, bone conductivity, reabsorption, and three-dimensional shaping. (2) There are many factors that affect the surface microstructure of the biomaterial. As for the same biomaterial, greater surface energy/ wettability leads to better proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells; greater roughness better promotes the proliferation, adhesion, and differentiation of bone marrow mesenchymal stem cells; larger pore diameter and lower pore diameter rate are more prone to promote the osteogenic differentiation of bone marrow mesenchymal stem cells; greater substrate rigidity and elastic modulus better facilitate the osteogenic differentiation of bone marrow mesenchymal stem cells. The abovementioned factors of the biomaterials affect the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells. These findings help promote the application of biomaterials seeded with bone marrow mesenchymal stem cells in the clinic.

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    Application and significance of nanofibrous macroporous scaffold preparation technology for bone tissue engineering
    Zhang Weizhong, Li Lei, He He, He Xin
    2020, 24 (28):  4437-4444.  doi: 10.3969/j.issn.2095-4344.2302
    Abstract ( 425 )   PDF (49914KB) ( 48 )   Save

    BACKGROUND: Bionic porous scaffolds used in bone tissue engineering requires extracellular matrix-like nanofibrous and connected macroporous structure to effectively support cell implantation, adhesion, proliferation and other behaviors, and promote tissue regeneration.

    OBJECTIVE: To summarize the research progress in nanorfibrous macroporous scaffold preparation technology for tissue engineering based on the latest relevant research trends.

    METHODS: The first author searched Web of Science, CNKI and Baidu academic databases to retrieve papers published from 2000 to 2019 with the search terms “bone tissue engineering, nanofibrous, macroporous, scaffolds” in English and Chinese, respectively. Finally, 58 articles were included in result analysis.


    RESULTS AND CONCLUSION: The scaffolds with nanofibrous structures are fabricated using three strategies, including electrospinning, thermally induced phase separation, and self-assembly process. However, bone scaffold fabricated by a single strategy failed to provide interconnected macropores to simulate the microenvironment in the body, which was necessary for cell migration, growth, differentiation, proliferation, and tissue and organ regeneration. Therefore, it is now of great practical and scientific significance to develop macroporous nanofibrous scaffold using a combination of several strategies. Three-dimensional printing technique can provide precise structure and enables the customization of the internal structure and external shape of the scaffold, which promotes the development of bone tissue engineering technique.  

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    How does extracellular matrix-based growth factor delivery system promote osteogenesis?  
    Shi Jun, Yang Lin, Guo Zhibin, Cui Yutao, Liu He
    2020, 24 (28):  4445-4451.  doi: 10.3969/j.issn.2095-4344.2292
    Abstract ( 407 )   PDF (37932KB) ( 31 )   Save

    BACKGROUND: The local application of growth factor provides a promising therapeutic strategy for the treatment of refractory bone defects. However, there are still many factors that limit the application of the local growth factor delivery system, for example, inability to accurately control the amount of growth factors released and the low biological activity of the released growth factors.


    OBJECTIVE: To summarize a variety of growth factor delivery systems containing extracellular matrix components and the latest research progress regarding their application in the treatment of bone defects.

    METHODS: The first authors searched PubMed, Web of Science, Medline, Wanfang and CNKI databases to retrieve articles published during 2007-2019 with the search terms “extracellular matrix, integrins, heparin, heparin, growth factor, controlled delivery system, bone defect” in English and Chinese, respectively. A total of 317 articles were initially retrieved, and 59 of them were included in the final analysis.

    RESULTS AND CONCLUSION: Extracellular matrix components can combine and regulate the activity of growth factors and improve their bioavailability. Therefore, improvement of growth factor delivery system can be achieved by integrating extracellular matrix components into the growth factor delivery system. Compared with the common growth factor delivery system, the extracellular matrix growth factor delivery system can obtain better growth factor binding effect, higher biological activity and utilization, and even better targeted release, thus producing better effects on promoting bone regeneration. Therefore, the extracellular matrix growth factor delivery system provides a better therapeutic strategy for local treatment of refractory bone defects.

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    Scaffolds for dental pulp regeneration and revascularization
    Chen Leyi, Lü Xiaolin, Xu Wenan
    2020, 24 (28):  4452-4458.  doi: 10.3969/j.issn.2095-4344.2289
    Abstract ( 456 )   PDF (40290KB) ( 68 )   Save

    BACKGROUND: Rapid development in tissue engineering research and technology makes dental pulp regeneration and revascularization possible. The interactions of stem cells, scaffolds and signaling factors in tissue engineering are particularly important. Whether stem cells can proliferate, differentiate and develop dental pulp-like tissue greatly depends on the choice of scaffolds

    OBJECTIVE: To review the widely studied and effective scaffold materials and two methods of scaffold preparation and analyze their applications in dental pulp reconstruction and their revascularization ability.

    METHODS: The first author searched PubMed, Wanfang and CNKI databases using a computer for relevant articles published between January 1, 2019 and September 30, 2019 with the search terms “pulp regeneration, pulp revascularization, scaffold” in English, and “pulp regeneration, pulp revascularization, revascularization, scaffold” in Chinese. A total of 421 English articles and 181 Chinese articles were retrieved. Finally, 61 articles were reviewed.

    RESULTS AND CONCLUSION: Platelet-derived scaffolds, extracellular-matrix-derived scaffolds, and self-assembling peptide take effect in pulp regeneration and revascularization. Composite materials combining natural and synthetic materials prepared by hydrogel and nanomaterial techniques exhibited advantages in cell proliferation, differentiation, migration, adherence, anti-inflammation, and factor delivery. The modified composite materials have a strong ability to promote vascularization. With the development of scaffold design and preparation technology based on hydrogels and nanomaterials, problems regarding insufficient scaffold source and unstable clinical effect will be solved in the future. 

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    Research progress of biomaterials for repair of rotator cuff tear
    Xin Pengfei, Sun Youqiang, Li Jie, Chen Jianfa, Deng Baogui, Xiang Xiaobing
    2020, 24 (28):  4459-4464.  doi: 10.3969/j.issn.2095-4344.2309
    Abstract ( 534 )   PDF (37938KB) ( 178 )   Save

    BACKGROUND: Rotator cuff injury is the main cause of shoulder dysfunction in adults. The rate of retear is very high in patients with rotator cuff tear treated with simple surgical suture. Biological materials can optimize the biomechanical property after rotator cuff injury.

    OBJECTIVE: To review the latest research and clinical application of biomaterials in the repair of rotator cuff injury.

    METHODS: PubMed and Web of science databases were retrieved for the latest researches on the biomaterials for repair of rotator cuff. The search terms were “rotator cuff injuries; biological materials; autograft; extracellular matrix materials; synthetic materials; biological scaffold; biological patch; augmentation”. Fifty-seven articles were classified and compared to discuss the advantages and disadvantages of various repair biomaterials.

    RESULTS AND CONCLUSION: Currently, the biomaterials for repair of rotator cuff injury can be divided into three categories: untreated human tissue transplantation materials, extracellular matrix materials and synthetic materials. The latest clinical reports show that untreated human tissue transplantation materials often have different clinical effects. The results of extracellular matrix materials derived from human allogenic dermal materials are still acceptable. Most scholars do not recommend the use of small intestinal submucosal grafts from pigs. The latest three-dimensional collagen scaffolds and synthetic absorbable materials have good application prospects due to their good porosity and the ability to induce the healing of tendon and bone tissues. However, most of them are still in the stage of animal experiments, and more clinical trials are needed to confirm their safety and effectiveness. There is no safe and effective biomaterial to treat rotator cuff tear. With the development of tissue engineering technology and materials science, it is expected to find a satisfactory material in the future by combining the macroscopic properties of biological scaffolds or synthetic materials with the microscopic properties of stem cells or cytokines.

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    A drug-loading system for electrospinning wound repair: component selection and construction strategy
    Liu Yanhua, Zhu Zhou, Wan Qianbing
    2020, 24 (28):  4465-4473.  doi: 10.3969/j.issn.2095-4344.2305
    Abstract ( 812 )   PDF (61595KB) ( 80 )   Save

    BACKGROUNDAs an excellent material in recent years, electrospinning membrane provides a new method to promote the healing of wound. Based on the diversity of its fibrous base and active components, it is flexible to build a drug delivery system for electrospinning wound repair.

    OBJECTIVE: To summarize the mechanism and functional characteristics of the components belonging to electrospinning fiber membrane drug-loading system, and to guide the selection of construction strategies for wound healing materials.

    METHODS: The literature search was performed in Web of Science, PubMed, CNKI, and WanFang databases. The key words were “electrospinning, wound dressing, nanofibers, wound healing, drug deliver”. Ninety articles were included in this review finally.

    RESULTS AND CONCLUSION: The construction strategies of electrospinning wound repair drug-delivery system were diverse. Through electrospinning technology, different polymers could be used to carry stem cell components or other small functional bioactive “drugs”, thus constructing a variety of effective composite systems. These materials might be applied to all aspects of the wound healing process, and finally achieve the purpose of promoting wound soft tissue healing. The excellent drug-loading system/drug-loading strategies have expanded the vision of wound treatment. Compared with traditional hydrogel and accessory treatment products, the multi-mechanism, function and possibility characteristics of electrospinning wound repair drug-delivery system determined its advantages in wound treatment.

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    Research status of dynamic three-dimensional tissue culture driving methods
    Yang Yong, Lü Chenze, Xu Ming’en, , Wang Ling,
    2020, 24 (28):  4474-4484.  doi: 10.3969/j.issn.2095-4344.2291
    Abstract ( 534 )   PDF (62725KB) ( 66 )   Save

    BACKGROUND: In vitro models are widely used in toxicology, pathology, and pharmaceutical research due to their short experimental cycles, low cost, and small species differences compared with animal models. Dynamic three-dimensional tissue culture mode is an important trend in the development of in vitro models. Dynamic three-dimensional culture in vitro models can be achieved by means of driving fluids in microfluidic systems.

    OBJECTIVE: To describe the microfluidic driving methods in the field of microfluidics, their respective advantages and disadvantages, and the application of different driving methods to different tissue culture requirements.

    METHODS: A computed-based retrieval of CNKI and Web of Science databases was performed for the articles concerning dynamic three-dimensional tissue culture and microfluidic driving methods to achieve dynamic culture of cells or tissues. The search terms were “microfluidic; micropump; organ-on-chip; three-dimensional tissue culture” in English and Chinese, respectively.

    RESULTS AND CONCLUSION: The microfluidic driving methods include passive driving and active driving. Whereas passive driving includes surface tension pump, osmotic pump and gravity pump. Active driving includes syringe pump and peristaltic pump. Each driving method has its advantages and disadvantages. To achieve accurate control of the medium flow rate in a dynamic three-dimensional tissue culture system, the best choice is to use syringe pumps or valve-type peristaltic pumps. To achieve closed-loop flow of culture medium in a dynamic three-dimensional tissue culture system, the best choice is to use gravity pumps or peristaltic pumps. To fulfill the need for a sterile environment in the experimental process in a dynamic three-dimensional tissue culture system, the best choices are surface tension pumps, gravity pumps, and pneumatic peristaltic pumps. To achieve high-throughput culture in dynamic three-dimensional tissue culture systems, the best choices are surface tension pumps, gravity pumps and pneumatic peristaltic pumps.

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    Nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft for the treatment of ARCO stage III osteonecrosis of the femoral head
    Yue Ju’an, Guo Xiaozhong, Wang Randong, Li Bing, Sun Qiang, Zhang Qidong, Liu Wangyan, Chen Jiao, Li Yingnan
    2020, 24 (28):  4485-4491.  doi: 10.3969/j.issn.2095-4344.2320
    Abstract ( 540 )   PDF (27123KB) ( 30 )   Save

    BACKGROUND: It remains controversial whether patients with ARCO stage III osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is.

    OBJECTIVE: To investigate the clinical efficacy of nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft in the treatment of ARCO stage III osteonecrosis of the femoral head

    METHODS: From March 2017 to September 2018, 36 patients (32 male and 4 female, 16-58 years old) with ARCO state III osteonecrosis of the femoral head who received treatment in Aviation General Hospital were included in this study. Among these patients, three had bilateral osteonecrosis of the femoral head and 33 had unilateral osteonecrosis of the femoral head. According to ARCO classification, 35 hips fell into stage IIIA, 3 hips in stage IIIB, and 1 hip in stage IIIC. All included paitents underwent nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft. Postoperative follow up was performed. Hip joint function was evaluated using Harris hip score. The degree of collapse of the femoral head was evaluated using X-ray imaging. The osteogenesis in the necrotic area was determined by CT scans. This study was approved by Aviation General Hospital Ethics Committee (Ethics code: HK2019-01-04).

    RESULTS AND CONCLUSION: (1) Thirty-six patients were followed up for (19.28±6.51) months. At the last follow-up, 4 hips ultimately underwent total hip arthroplasty with the success rate of 89.7%(35/39). (2) Harris hip score revealed that at the last follow-up, the excellent and good rate of hip function was significantly higher than that before surgery (71.8%,17.5%, P=0.000). (3) Last follow-up CT scans revealed obvious osteogenesis was observed in 26 of 35 hips at ARCO stage IIIA and it was observed in neither 3 hips at ARCO stage IIIB nor in 1 hip at ARCO stage IIIC. (4) At the last follow-up, X-ray showed that there was progress in 5 of the 35 hips (IIIA), 3 of which progressed to ARCO stage IIIB, 2 to ARCO stage IV, and the remaining 30 hips were stable without progression; three hips in ARCO stage IIIB progressed, including 2 progressed to ARCO stage IIIC and 1 to ARCO stage IV; 1 hip in ARCOIIIC stage progressed to ARCO stage IV. The results suggest that nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft has a good effect on the treatment of ARCO stage III osteonecrosis of the femoral head. 

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    Effects of sustained-release atorvastatin calcium nanofiber scaffold on cell adhesion and proliferation
    Wang Le, Hui Min, Dong Xiling, Zhou Han, Dong Hongliang, Zhang Xiaoming, Liu Tongbin
    2020, 24 (28):  4492-4497.  doi: 10.3969/j.issn.2095-4344.2310
    Abstract ( 390 )   PDF (24807KB) ( 49 )   Save

    BACKGROUND: Statins plays a significant role in regulating blood lipids, treating and preventing cardiovascular and cerebrovascular diseases. Studies have shown that statins has certain potential in promoting bone formation and treating osteoporosis.

    OBJECTIVE: To prepare the drug release scaffolds for the sustained release of atorvastatin calcium, which consist of bovine serum albumin microspheres and polycaprolactone electrostatic spinning fibers, and to investigate the effects of the drug sustained release scaffolds on osteoblast adhesion and proliferation.

    METHODS: Bovine serum albumin microspheres containing atorvastatin calcium were prepared by desolvation. A layer of chitosan was coated on the surface of the bovine serum albumin microspheres by electrostatic adsorption, which can increase the stability of the microspheres. Bovine serum albumin microspheres were purified and lyophilized for later use. The lyophilized powder of microspheres was dissolved in organic solvent. An appropriate amount of hydroxyapatite was added in the solvent. The nanofiber scaffolds for sustained release of atorvastatin calcium were prepared via electrospinning. The micromorphology, degradation performance, and sustained-release performance of the nanofiber scaffolds were characterized. The prepared nanofiber scaffolds for sustained-release of atorvastatin calcium were co-cultured with MC3T3-E1 cells to observe cell adhesion and proliferation.

    RESULTS AND CONCLUSION: (1) Transmission electron microscopy revealed that the shape of the bovine serum albumin nanospheres was regular and circular. Bovine serum albumin nanospheres were discarded in the electrostatic spinning fibers. The basic morphology of the microspheres was retained. (2) Scanning electron microscopy revealed that the nanofibers used for preparation of nanofiber scaffolds for sustained-release of atorvastatin calcium were composed of filaments with uniform diameters and continuous smooth surface. Filaments were intertwined to form a network structure. (3) The nanofiber scaffolds exhibited the fastest degradation in the first month. The material was incomplete when degraded for 3 months. (4) The nanofiber scaffolds had the ability to slow down the release of drugs. The effect could last for more than 1 month. The overall process of drug release was similar to the zero-order kinetic process. (5) The nanofiber scaffolds for sustained-release of atorvastatin calcium can promote MC3T3-E1 cell adhesion and proliferation. (6) These results suggest that the nanofiber scaffolds for sustained-release of atorvastatin calcium have good biocompatibility and can promote the adhesion and proliferation of osteoblasts.

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    Effect of bone cement distribution on adjacent vertebral body fracture after unilateral percutaneous vertebroplasty for single segment osteoporotic vertebral compression fracture
    Liu Ruizhen, Wang Wangren, Hao Chen, Liang Dongmu, Guan Haishan
    2020, 24 (28):  4498-4504.  doi: 10.3969/j.issn.2095-4344.2304
    Abstract ( 357 )   PDF (32166KB) ( 58 )   Save

    BACKGROUND: Previous studies on the risk factors of adjacent vertebral fractures after percutaneous vertebroplasty at home and abroad mainly focus on the leakage of bone cement, the amount of bone cement injected, the viscosity of bone cement, the number and location of vertebral fractures, the loss of vertebral height and sex.

    OBJECTIVE: To predict and analyze the influence of bone cement distribution on adjacent vertebral body fracture after unilateral percutaneous vertebroplasty for single segment osteoporotic vertebral compression fracture.

    METHODS: Forty patients with single segment osteoporotic vertebral compression fracture, including 16 males and 24 females, aged (71.4 ±5.3) years who received percutaneous vertebroplasty in the Second Affiliated Hospital of Shanxi Medical University from June 2017 to June 2018 were included in this study. These patients were divided into a unilateral group (13 vertebrae in 13 cases) and a bilateral group (27 vertebrae in 27 cases) according to the distribution of bone cement shown on X-ray film. Patients in the unilateral group were sub-divided into groups A (8 vertebrae in 8 cases, contacting the upper and lower endplates at the same time) and B (5 vertebrae in 5 cases, not contacting the upper and lower endplates at the same time) according to whether bone cement contacted the upper and lower endplates at the same time. Patients in the bilateral group were sub-divided into groups C (11 vertebrae in 11 cases, contacting the upper and lower endplates at the same time) and D (16 vertebrae in 16 cases, not contacting with the upper and lower endplates at the same time). Visual analogue scale score, Oswestry disability index, and Cobb angle were compared between unilateral and bilateral groups before and 1 year after surgery. The compression rate between adjacent vertebral bodies and the angle between the upper and lower endplates were compared between groups A, B, C and D. This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Shanxi Medical University.

    RESULTS AND CONCLUSION: (1) At 1 year after surgery, the Visual Analogue Scale score, Oswestry disability index, and Cobb angle in both unilateral and bilateral groups were significantly decreased compared with before surgery (P < 0.001). There were no significant differences in these indices between unilateral and bilateral groups (P > 0.05). (2) At 1 year after surgery, the compression rate between adjacent vertebral bodies in groups A-D was significantly increased compared with before surgery (P < 0.05), and the angle between the upper and lower endplates in groups A-D was significantly increased compared with before surgery (P < 0.05). (3) Disordered multiclass logistic regression analysis taking group D as reference showed that the compression degree of adjacent vertebrae in group A was the largest after percutaneous vertebroplasty, which was the risk factor of the compression change of adjacent vertebrae after surgery (P=0.003). Group B and group C were not the risk factors of the compression change of adjacent vertebrae after percutaneous vertebroplasty [P=0.065, 0.660]. (4) These results show that after percutaneous vertebroplasty, if bone cement is distributed unilaterally and closer to the upper and lower endplates of the vertebral body at the same time, then the trend of adjacent vertebral body fracture is greater. Therefore, prediction of bone cement distribution of this type is a risk factor of adjacent vertebral body fracture after percutaneous vertebroplasty.

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    Effect of different distribution types of bone cement after percutaneous kyphoplasty on osteoporotic vertebral compression fractures at different sites  
    Xie Hui, Chen Haopeng, Wang Benjie, Fu Weimin, Zhao Dewei
    2020, 24 (28):  4505-4510.  doi: 10.3969/j.issn.2095-4344.2298
    Abstract ( 408 )   PDF (25279KB) ( 37 )   Save

    BACKGROUND: Percutaneous kyphoplasty (PKP) has become an effective method for the treatment of osteoporotic vertebral compression fractures, but the distribution of bone cement in the vertebral body can cause certain differences in postoperative clinical symptoms.

    OBJECTIVE: To investigate the clinical effect of bone cement distribution on the treatment of vertebral compression fractures in different sites after percutaneous kyphoplasty.

    METHODS: A retrospective analysis of eligible 339 patients with vertebral compression fractures at different sites who received treatment at the Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University from January 2017 to January 2019 were included in this study. These patients were aged 60-85 years. They were divided into a thoracic fracture group (n=144) and a lumbar fracture group (n=195). All patients received bone cement injection after percutaneous kyphoplasty. After surgery, the diffusion distribution of bone cement in the vertebral body was divided into I-V types in each group. Visual Analogue Scale score and Oswestry Disability Index were evaluated before surgery, and 3 days and 6 months after surgery. This study was approved by the Medical Ethics Committee, Affiliated Zhongshan Hospital of Dalian University, China.

    RESULTS AND CONCLUSION: (1) At 3 days and 6 months after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly decreased compared with before surgery (P < 0.05). Visual Analogue Scale score and Oswestry Disability Index at 6 months after surgery were significantly lower than those at 3 days after surgery (P < 0.05). (2) At 6 months after surgery, there were no significant differences in Visual Analogue Scale score and Oswestry Disability Index between thoracic fracture and lumbar fracture groups when the distribution type of bone cement was the same (P > 0.05). (3) At 6 months after surgery, there was no significant difference in Oswestry Disability Index between different distribution types of bone cement in the thoracic fracture group (P > 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in those with types IV and V bone cement distribution (P < 0.05). (4) At 6 months after surgery, there was no significant difference in Oswestry Disability Index between different distribution types of bone cement in the lumbar fracture group (P > 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in that in patients undergoing types IV and V bone cement distribution (P < 0.05). (5) These results suggest that after percutaneous kyphoplasty, bone cement distributed in types I-III can lead to better pain relief than that distributed in other types.

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    Silicate-Cu/Mg bioactive ceramics promote the osteogenesis of osteoblasts
    Zhou Hangyu, Zeng Fuhai, Xia Delin
    2020, 24 (28):  4511-4517.  doi: 10.3969/j.issn.2095-4344.2327
    Abstract ( 398 )   PDF (29575KB) ( 30 )   Save

    BACKGROUND: The use of silicate bioceramics as a tissue-engineered bone scaffold has poor ability to promote osteogenesis. Studies have shown that copper, magnesium, and other essential trace elements have obvious effects on the induction and stimulation of osteoblasts and hemangioblasts.

    OBJECTIVE: To investigate the effects of silicate bioactive ceramics with Cu and Mg on osteoblast proliferation and osteogenesis.

    METHODS: Cu-silicate bioceramics, Mg-silicate bioceramics, and Cu-Mg-silicate bioactive ceramics were prepared by the sol-gel method (molar ratio of both Cu and Mg in ceramics was 5%). Three experimental groups were CS-5Cu, CS-5Mg, CS-5Cu/5Mg groups. The silicate bioactive ceramics served as the control group (denoted as CS). X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy were used to characterize the samples. The surface crystallization of bioceramics was detected. Osteoblasts were co-cultured with four groups of ceramics for 24 hours. Osteoblast proliferation index, alkaline phosphatase secretion, osteopontin and osteocalcin gene expression, vinculin and actin protein expression were determined.  

    RESULTS AND CONCLUSION: (1) The crystallization ability of different silicate bioceramic samples followed the order of CS-5Cu>CS>CS-5Cu/5Mg>CS-5Mg. (2) Osteoblast proliferation index followed the rule of CS-5Cu/5Mg>CS-5Cu≈CS-5Mg>CS. (3) Alkaline phosphatase secretion was in the order of CS-5Cu/5Mg>CS-5Cu≈CS-5Mg>CS. (4) Osteopontin and osteocalcin gene expression followed the rule of CS-5Cu/5Mg>CS-5Cu≈CS-5Mg>CS. (5) Vinculin and actin protein expression was in the order of CS-5Cu/5Mg>CS-5Cu≈CS-5Mg>CS. (6) These results suggest that Cu- or Mg-silicate, in particular Cu-Mg-silicate bioactive ceramics can promote the proliferation of osteoblasts and the expression of osteogenesis-related genes as well as cell adhesion and spreading. 

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    Properties of a novel photocrosslinked fish collagen peptide-hyaluronic acid hydrogel
    Guo Enhui, Xu Zitong, Liang Yize, Zhou Liang, Lu Zhaoxiang, You Liang, Xia Yujun
    2020, 24 (28):  4518-4525.  doi: 10.3969/j.issn.2095-4344.2284
    Abstract ( 432 )   PDF (36816KB) ( 33 )   Save

    BACKGROUND: A novel photocrosslinked fish collagen peptide-hyaluronic acid hydrogel has been successfully prepared by the research group.

    OBJECTIVE: To investigate the microstructure and the swelling properties in vitro of the photocrosslinked fish collagen peptide-hyaluronic acid hydrogel, and its histocompatibility and degradability in vivo.

    METHODS: A new photocrosslinked fish collagen peptide-hyaluronic acid hydrogel was prepared by photocrosslinking, and then divided into groups A (30 g/L), B (50 g/L) and C (100 g/L) according to the content of fish collagen peptide. The microstructure of the hydrogel was observed by scanning electron microscope and the swelling properties of hydrogels were studied by swelling test in vitro. Fifteen male Sprague-Dawley rats (provided by Qingdao Qinda Breeding Co., Ltd.) were selected, and three kinds of photocrosslinked fish collagen peptide-hyaluronic acid hydrogels were implanted into the back of rats. At 1, 2, 4, 6 and 8 weeks after surgery, three rats were selected for detecting the histocompatibility and biodegradability of hydrogels. The study was approved by the Ethics Committee of School of Basic Medicine, Qingdao University.

    RESULTS AND CONCLUSION: (1) With the increase of fish collagen peptide content, the transparency of hydrogel decreased and the pore size of hydrogel decreased. (2) Swelling equilibrium was achieved within 100 minutes in each group, and the swelling velocity and equilibrium swelling rate were inversely proportional to the content of collagen peptide. The equilibrium swelling rate was highest in the group A, which was 1 582%. (3) The hydrogel had good histocompatibility, mild inflammatory reaction, no infection, hematoma or other complications in vivo. (4) At 1 week after implantation, inflammatory cell infiltration was observed surrounding the hydrogels. The level of inflammatory cells peaked at 2 weeks, and then decreased gradually. The count of inflammatory cells was highest in the group A, followed by group B, and lowest in the group C (P < 0.05). (5) After implanted into the back of rats, three kinds of hydrogels began to degrade, and residue still existed up to 8 weeks. The order of degradation rate at each time point was as follows: group A > group B > group C (P < 0.05). (6) These results indicate that photocrosslinked fish collagen peptide-hyaluronic acid hydrogel has good histocompatibility and biodegradability in vivo, which can be adjusted by the content of fish collagen peptides. 

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    Effect of nanoparticles carrying chondroitin sulfate ABC on the migration of Schwann cells in a magnetic field
    Gao Jianbo, Xia Bing, Li Shengyou, Yang Yujie, Ma Teng, Yu Peng, Luo Zhuojing, Huang Jinghui
    2020, 24 (28):  4526-4532.  doi: 10.3969/j.issn.2095-4344.2069
    Abstract ( 399 )   PDF (28817KB) ( 28 )   Save

    BACKGROUND: The clinical effect of spinal cord injury is usually unfavorable due to the lack of axon regeneration and the formation of glial scar. Schwann cells, as the support cells for nerve regeneration, have poor migration ability in the central nervous system with abundant astrocytes, which limit its effect on axon regeneration.

    OBJECTIVE: To explore the effect on the migration of Schwann cells containing superparamagnetic nanoparticles loaded with chondroitinase ABC (ChABC) in the region of astrocytes in the external magnetic field.

    METHODS: Schwann cells and astrocytes were extracted from sciatic nerves and brachial plexus and cerebral cortex of Sprague-Dawley rats of postnatal day 1 to 3. Cell purity was identified by immunofluorescence staining. The toxicity of superparamagnetic nanoparticles (PEI-SPIONs) to Schwann cells was analyzed by live/dead cell staining. Schwann cells were transfected with PEI-SPIONS in an external magnetic field of 1.4Td for 2 days. The optimal transfection concentration of PEI-SPIONS used was 2 mg/L and the optimal mass ratio of PEI-SPIONS to ChABC was 1:4. Cell migration test was used to evaluate the migration ability of not-treated Schwann cells, PEI-SPIONs/ ChABC transfected Schwann cells, and PEI-SPIONs/ChABC transfected Schwann cells in an external magnetic field.

    RESULTS AND CONCLUSION: The purity of Schwann cells and astrocytes reached to (91.7±1.2)% and (93.3±2.2)%, respectively. Compared with the Schwann cells group, the number of PEI-SPIONs/ChABC-transfected Schwann cells that entered the region of astrocytes was significantly increased (P < 0.05). Under the external magnetic field, the number of PEI-SPIONs/ChABC-transfected Schwann cells that entered the region of astrocytes and the cell migration distance were significantly increased as compared with the Schwann cells group (P < 0.005). In summary, PEI-SPIONs/ChABC transfection can enhance the ability of Schwann cells to break the glial scar, and increase the fusion of astrocytes. Under the guidance of external magnetic field, the migration ability of Schwann cells is significantly elevated. This method may be a new strategy to promote nerve regeneration after spinal cord injury.

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    Calcium hydrogen phosphate dehydrate combined with gelatin and recombinant human bone morphologic protein 2/7 for repair of bone defects in rabbits
    Li Xuewei, Hu Beibei, Zhang Dawei, Quan Lulu, Liang Yongqiang
    2020, 24 (28):  4533-4539.  doi: 10.3969/j.issn.2095-4344.2314
    Abstract ( 320 )   PDF (28171KB) ( 28 )   Save

    BACKGROUND: Studies have shown that the osteogenic ability of 10% strontium-doped calcium hydrogen phosphate dihydrate is higher than that of calcium hydrogen phosphate dihydrate and 5% strontium-doped calcium hydrogen phosphate dihydrate, but also found that the pore structure of 10% strontium-doped calcium hydrogenphosphate dihydrate is not ideal, and the early osteogenic effect is not satisfactory.

    OBJECTIVE: To investigate the osteogenic effect of the composite of 10% strontium-doped calcium hydrogenphosphate dehydrate and gelatin and recombinant human bone morphogenetic protein 2/7 (rhBMP2/7).  

    METHODS: Gelatin-10% strontium-doped calcium hydrogenphosphate dihydrate and gelatin-10% strontium-doped calcium hydrogenphosphate dihydrate material containing 0.04 g/L and 1 g/L rhBMP2/7 were prepared respectively. Forty-five rabbit models of bilateral mandibular defects were prepared and then divided into five groups. In the blank control group, no material was implanted. 10% strontium-doped calcium hydrogen phosphate dihydrate (control group) and gelatin-10% strontium-doped calcium hydrogen phosphate dihydrate (gelatin group), 0.04 g/L rhBMP2/7-gelatin-10% strontium-doped calcium hydrogenphosphate dihydrate (0.04 g/L rhBMP2/7 group), and 1 g/L rhBMP2/7-gelatin-10% strontium-doped calcium hydrogenphosphate dihydrate (1 g/L rhBMP2/7 group) were implanted in the remaining four groups, respectively. Bone defect specimens were taken at 4, 8 and 12 weeks after surgery, and were examined by cone beam CT and immunohistochemistry. This study was approved by the Animal Ethics Committee of North China University of Science and Technology, China.

    RESULTS AND CONCLUSION: Cone beam CT examination revealed that at 8 weeks after surgery, bone repair was basically completed and the new bone tissue was almost fused with the surrounding tissue in the 1 g/L rhBMP2/7 group. Most of defect area was repaired, and the edge of new bone was unsmooth in the 0.04 g/L rhBMP2/7 and gelatin groups. Bone defect in the control group partially repaired. At 12 weeks after surgery, bone repair was completed in the gelatin, 0.04 rhBMP2/7 and 1 g/L rhBMP2/7 groups. Immunohistochemistry revealed that at 4 and 8 weeks after surgery, type I collagen expression in the 1 g/L rhBMP2/7 group was significantly higher than that in the other four groups  (P < 0.05). Type I collagen expression in the 0.04 g/L rhBMP2/7 and gelatin groups was significantly higher than that in the control group (P < 0.05). At 12 weeks after surgery, there was no significant difference in type I collagen expression between collagen, gelatin, 0.04 rhBMP2/7 and 1 g/L rhBMP2/7 groups (P > 0.05). These results suggest that the addition of gelatin and 1 g/L rhBMP2/7 to 10% strontium-doped calcium hydrogenphosphate dihydrate can promote the repair of bone defects.

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    Regulation of stem cells by transforming growth factor β3/polylactic acid-glycolic acid microspheres
    Yang Zhen, Li Hao, Gao Cangjian, Fu Liwei, Tian Guangzhao, Zha Kangkang, Sun Zhiqiang, Li Xu, Guo Weimin, Sui Xiang, Huang Jingxiang, Liu Shuyun, Lu Shibi, Guo Quanyi
    2020, 24 (28):  4540-4546.  doi: 10.3969/j.issn.2095-4344.2296
    Abstract ( 499 )   PDF (32552KB) ( 40 )   Save

    BACKGROUND: Transforming growth factor β3/polylactic acid-glycolic acid (TGF-β3/PLGA) sustained-release microspheres can maintain the effective drug concentration at the site of action and provide the feasibility for efficient utilization of growth factors.

    OBJECTIVE: To optimize the manufacturing process of TGF-β3/PLGA sustained-release microspheres, and investigate their effects on the proliferation and migration of rabbit adipose-derived mesenchymal stem cells (ADSCs).

    METHODS: TGF-β3/PLGA sustained-release microspheres were prepared by emulsification-solvent evaporation method. The morphology, particle size, drug spatial distribution, encapsulation efficiency, drug loading, and sustained release properties of the microspheres were characterized. The TGF-β3/PLGA sustained-release microspheres were dissolved in phosphate buffered saline. The concentration of TGF-β3 in the supernatant was detected at the corresponding time points. The microsphere morphology was observed by scanning electron microscopy at the corresponding time point. Adipose-derived mesenchymal stem cells were divided into six groups and then cultured with single culture medium (negative control) or culture medium containing TGF-β3 or blank PLGA, or culture medium containing 10,100,1 000 g/L TGF-β3/PLGA microspheres. Cell proliferation was detected by CCK-8 assay at the corresponding time point. Cells in each group were cultured for 24 hours with corresponding medium in a non-contact manner. The number of migratory cells was counted.

    RESULTS AND CONCLUSION: (1) TGF-β3/PLGA sustained-release microspheres were spherical with smooth surface, no adhesion, and evenly distributed particle size. The microspheres had a diameter of 2-50 μm, and the protein drugs in the microspheres were evenly distributed, with high encapsulation efficacy and encapsulation dose. (2) The TGF-β3/PLGA sustained-release microspheres had good degradation properties and were completely degraded after 6 months in vitro. At the same time, these microspheres had good sustained-release performance and released TGF-β3 slowly for 45 days in vitro. (3) Blank microspheres and the sustained-release microspheres containing TGF-β3 had no effect on the proliferation of adipose-derived mesenchymal stem cells. (4) Blank microspheres had no effect on the migration of adipose-derived mesenchymal stem cells, and the transforming growth factor 3 and the sustained-release microspheres containing TGF-β3 promoted the migration of adipose-derived mesenchymal stem cells. There was no significant difference in the migration promotion between different concentrations of TGF-β3. (5) These findings suggest that the TGF-β3/PLGA sustained-release microspheres can promote the migration of adipose-derived mesenchymal stem cells without affecting their proliferation.

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    Diffusion tensor imaging predicting locomotor function recovery with 3D printing scaffold after spinal cord injury
    Liu Xiaoyin, , Zhong Lin, Zheng Bo, Wei Pan, Dai Chen, Hu Liangcong, Wang Tiantian, Liang Xiaolong, Zhang Sai, Wang Xiaoli
    2020, 24 (28):  4547-4554.  doi: 10.3969/j.issn.2095-4344.2297
    Abstract ( 321 )   PDF (34852KB) ( 38 )   Save

    BACKGROUNDDiffusion tensor imaging, as a relatively new method based on MRI, has become an important means of examination and diagnosis in the field of neuroimaging.

    OBJECTIVE: To investigate the role of using diffusion tensor tensor imaging data to predict 3D-bioprinted collagen/silk fibroin scaffolds in the locomotor function recovery after spinal cord injury.

    METHODS: Ordinary and 3D-bioprinted collagen/silk fibroin scaffold were prepared. Forty adult female SD rats provided by the Laboratory Animal Center of the Academy of Military Medical Sciences of the People’s Liberation Army were randomly divided into four groups with 10 rats in each group. In the sham operation group, only T10 vertebral plate was removed. In the model group, spinal cord injury was induced by total transection of spinal cord at T10 segment. In the ordinary collagen scaffold and 3D-printed scaffold groups, after induction of T10 spinal cord injury, ordinary collagen scaffold and 3D-printed scaffold were implanted, respectively. At 1, 2, 3, 4, 6 and 8 weeks after surgery, Basso, Beattie and Bresnahan (BBB) locomotor function scoring and oblique plate test of the hind limbs were carried out. At 8 weeks after surgery, electrophysiological test of the hind limbs was performed to evaluate locomotor function. At 8 weeks after surgery, diffusion tensor imaging of the lumbar spine was performed and the correlation between diffusion tensor imaging parameter and rat locomotor function was analyzed. Animal experiments were approved by the Animal Ethics Committee of Characteristic Medical Center of the Chinese people's Armed Police Force (approval No. 27653/58).

    RESULTS AND CONCLUSION: (1) From 3 weeks after surgery, BBB score in the 3D-printed group was significantly higher than that in the model and ordinary collagen scaffold groups (P < 0.05 or P < 0.01). From 2 weeks after surgery, the slope angle in the 3D-printed scaffold group was significantly higher than that in the model and ordinary scaffold groups (P < 0.05 or P < 0.01). (2) The amplitude of motor evoked potential in the 3D-printed scaffold group was significantly greater than that in the model and ordinary collagen scaffold groups (P < 0.05 or P < 0.01). The latency of motor evoked potential in the 3D-printed scaffold group was significantly shorter than that in the model and ordinary collagen scaffold groups (P < 0.05 or P < 0.01). (3) Diffusion tensor imaging showed that the nerve fiber trajectories in the three groups were irregular and lacked the continuity of nerve fibers, but the number of regenerated nerve fiber bundles in the 3D-printed collagen scaffold group was greater than that in the model and ordinary collagen scaffold groups (P < 0.01). The fractional anisotropy at 9, 7.5, 4.5, -3, -6, -7.5, -9 mm from the center of spinal cord injury in 3D-printed collagen scaffold group was significantly higher than that in model and ordinary collagen scaffold groups (P < 0.05 or P < 0.01). (4) The BBB score, slope angle, amplitude of motor evoked potential, latency of motor evoked potential were positively correlated with the fractional anisotropy value of diffusion tensor imaging from head to tail of rats. (5) These results suggest that diffusion tensor imaging can be used as an effective predictor to evaluate the recovery of neurological function after spinal cord injury in experimental animals and clinical cases.

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    Comparison of immune responses of acellular vascular materials prepared by the two methods in animals
    Yin Jing, Wang Dan, Wang Peng, Zhang Hong, Jiang Haijun
    2020, 24 (28):  4555-4561.  doi: 10.3969/j.issn.2095-4344.2329
    Abstract ( 387 )   PDF (25595KB) ( 45 )   Save

    BACKGROUND: As a mature method of decellularization at present, descaling agent has the advantages of simple operation, small damage, and easy control of experimental conditions. Some studies have combined different descaling agents to achieve good results in decellularization.

    OBJECTIVE: To compare the effect of two descaling agents and the immune response of two kinds of acellular vascular materials subcutaneously implanted into animals.

    METHODS: Two methods were used to treat the porcine carotid artery for descaling agent. One group was treated in the mixed solution of 1% sodium dodecyl sulfate and 1% sodium deoxycholate for 72 hours; the other group was treated in the mixed solution of 1% sodium dodecyl sulfate and 1% Triton X-100 for 72 hours. After cell removal, histological analysis, scanning electron microscope analysis, mechanical analysis and DNA content detection were carried out. Two groups of acellular vascular materials were implanted subcutaneously in the back of SD rats. After 1, 2, 4 and 8 weeks, the grafted vascular materials were taken out for hematoxylin and eosin and immunofluorescence staining. This study was approved by the Animal Ethics Committee of Jiangnan University.

    RESULTS AND CONCLUSION: (1) Histological analysis showed that 1% sodium dodecyl sulfate combined with 1% sodium deoxycholate effectively removed the cell components and retained the extracellular matrix structure, and the effect of cell removal was better than 1% sodium dodecyl sulfate combined with 1% Triton X-100. (2) The DNA content of 1% sodium dodecyl sulfate combined with 1% sodium deoxycholate group was significantly lower than that of 1% sodium dodecyl sulfate combined with 1% Triton X-100 group (P < 0.05). There were no significant differences in bursting strength and suture tolerance between the two schemes (P > 0.05). (3) Scanning electron microscopy showed that 1% sodium dodecyl sulfate combined with 1% Triton X-100 significantly damaged the extracellular matrix compared with 1% sodium dodecyl sulfate combined with 1% sodium deoxycholate. (4) In the subcutaneous implantation experiment, a large number of inflammatory cells infiltrated around the carotid artery materials of the two groups at 1 week after operation. No inflammatory cells infiltrated around the acellular materials of 1% sodium dodecyl sulfate and 1% sodium deoxycholate at 8 weeks after operation. Lymphocyte infiltrated around the acellular materials of 1% sodium dodecyl sulfate and 1% Triton X-100 group. 1% sodium dodecyl sulfate combined with 1% Triton X-100 acellular material mainly induced macrophages to differentiate into M1 type. 1% sodium dodecyl sulfate combined with 1% sodium deoxycholate acellular material mainly induced macrophages to differentiate into M2 type. (5) Compared with 1% sodium dodecyl sulfate and 1% Triton X-100, 1% sodium dodecyl sulfate and 1% sodium deoxycholate are more promising cell-free treatment.

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    Endothelialization of acellular scaffold from sterilized bovine pericardium
    Liu Fei, Zhang Guanxin, Liu Xiaohong, Wang Licheng, Xu Zhiyun
    2020, 24 (28):  4562-4566.  doi: 10.3969/j.issn.2095-4344.2307
    Abstract ( 432 )   PDF (22938KB) ( 70 )   Save

    BACKGROUND: In the research of tissue engineering, there are inevitably various kinds of microorganisms attached to animal tissues, and asepsis is a basic requirement of clinical application of tissue engineering materials.

    OBJECTIVE: To investigate the effect of 75% ethanol sterilization on the properties and biocompatibility of bovine pericardium.

    METHODS: Bovine pericardial tissue was sterilized with sterile PBS (control group), PBS containing 1% antibiotic (penicillin/streptomycin/ amphotericin B solution), chlorhexidine and 75% ethanol. LB solid medium was used to evaluate the bactericidal effect of four methods. VB staining was used to evaluate the effect of four sterilization treatments on the tissue structure of bovine pericardium. The cytotoxicity of four sterilized extracts was determined by the CCK-8 assay. The bovine pericardium was sterilized with 75% ethanol and then used to make acellular scaffold, which was co-cultured with human umbilical vein endothelial cells to observe the effect of cell adhesion and endothelialization.

    RESULTS AND CONCLUSION: (1) The bovine pericardium treated with 75% ethanol and chlorhexidine for 24 hours met the requirements of complete sterilization, and significant colony formation was observed in 1% antibiotic-treated and control groups. (2) VB staining revealed that the collagen fibers of bovine pericardium treated with 75% ethanol, chlorhexidine and 1% antibiotic were arranged in wavy pattern, with compact structure, less elastic fiber content but clear structure.(3) Bovine pericardium treated with 75% ethanol did not affect the proliferation activity of L929 cells, and the cell survival rate within 1-3 days was more than 100%. Chlorhexidine-sterilized bovine pericardium had strong cytotoxicity, leading to cell death. (4) Human umbilical vein endothelial cells grew and adhered normally on the surface of acellular scaffold. During the 20-day implantation period, the highest number of cells adhering to acellular scaffold appeared on days 8-12. These results suggest that 75% ethanol could effectively eliminate all microorganisms attached to the bovine pericardium without affecting the histological integrity and biocompatibility. 

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    Sonic hedgehog-polydopamine-fibrin scaffold promotes recovery of spinal cord injury in rats 

    Cao Sucheng, Xu Xiaofeng, Chen Qi, Lu Hao, Wang Zhe, Zhang Rui, Wang Yao, Zhang Zhijian, Yang Wenjing
    2020, 24 (28):  4567-4572.  doi: 10.3969/j.issn.2095-4344.2303
    Abstract ( 357 )   PDF (27440KB) ( 43 )   Save

    BACKGROUND: Recently, most studies have combined tissue engineering materials with stem cells or factors to improve the microenvironment of animal models of spinal cord injury to increase the duration of action, improve the recovery effect and prognosis.

    OBJECTIVE: To investigate the effect of sonic hedgehog-polydopamine-fibrin scaffold on the repair of spinal cord injury in rats.

    METHODS: Fibrin glue was made using a vacuum freeze-dryer. The prepared fibrin glue was immersed in a dopamine hydrochloride solution for 24 hours for cross-linking. Then the cross-linked scaffold was placed in a factor solution for adsorption and cross-linking for 24 hours. Sonic hedgehog-polydopamine-fibrin scaffolds were prepared. Sixty female SD rat models of spinal cord injury were established and then divided into four groups: In the group A, no material was implanted. In the groups B, C and D, fibrin scaffolds, polydopamine-fibrin scaffolds, and sonic hedgehog-polydopamine-fibrin scaffolds were implanted respectively. The Basso, Beattie and Bresnahan (BBB) locomotor scale score of lower limb locomotor function was evaluated within 12 weeks after surgery. At 12 weeks post-surgery, the tissue at the site of spinal cord injury was collected for histological observation (hematoxylin-eosin and immunohistochemical staining) and western blot assay. This study was approved by the Animal Ethics Committee of Jiangsu University, China.

    RESULTS AND CONCLUSION: (1) From 2 weeks after surgery, the lower limb locomotor function of rats in each group began to recovery. At 5-12 weeks after surgery, the BBB score of group D was significantly higher than that of the other three groups (P < 0.05). Rats in group D had the best recovery of locomotor function of the lower limb. (2) Hematoxylin-eosin staining revealed newly generated nerve fibers in the groups C and D, and that the number of density of new nerve fibers in group C was lower than that in group D. (3) Immunohistochemical staining showed that a large amount of linearly arranged new nerve fibers were observed in the completely transected site of rat spinal cord. In group D, myelin basic protein-, growth related protein- and neurofilament protein-positive rates were significantly higher (P < 0.05), and glial fibrillary acidic protein-positive rate was significantly lower, compared with the other three groups. (4) Western blot assay revealed that in group D, the protein expression of myelin basic protein, growth related protein and neurofilament protein was significantly higher (P < 0.05), and the protein expression of glial fibrillary acidic protein was significantly lower (P < 0.05), compared with the other three groups. (5) These results suggest that sonic hedgehog-polydopamine-fibrin has a good sustained-release performance, which can greatly promote the repair of spinal cord injury in rats. 

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    Safety of drug-coated balloon versus drug-eluting stents in the treatment of type 2 diabetes mellitus complicated by coronary artery small vessel disease in older adult patients

    Zheng Haijun, Jin Hui, Cui Hongling, Zhu Yakun, Zeng Hui, Han Fengjie, Qiu Cuiting, Liu Jing
    2020, 24 (28):  4573-4579.  doi: 10.3969/j.issn.2095-4344.2308
    Abstract ( 437 )   PDF (36136KB) ( 29 )   Save

    BACKGROUND: It has been found that drug-coated balloons can reduce the loss of lumen in the advanced stage of coronary small-vessel disease, and the incidence of major adverse cardiovascular events at 6 months after surgery with drug-coated balloons is similar to that of drug-eluting stents. However, clinical studies on the efficacy of drug-eluting stents in older adult patients with type 2 diabetes mellitus complicated by coronary artery small vessel disease are still lacking.

    OBJECTIVE: To investigate the efficacy and safety of drug-coated balloon versus drug-eluting stent in the treatment of type 2 diabetes mellitus complicated by coronary artery small vessel disease in older adult patients.

    METHODS: A total of 122 older adult patients with type 2 diabetes mellitus complicated by coronary artery small vessel disease who received treatment in Jiaozuo People’s Hospital between January 2016 and September 2018 were included in this study. These patients were randomly divided into a drug-eluting stent group (n=62) and a drug-coated balloon group (n=60). Patients in both groups underwent coronary artery predilation with a semi-compliant balloon, followed by implantation of corresponding stents. Selective quantitative coronary angiography was performed before surgery, immediately, 6 months and 12 months after surgery. The minimum lumen diameter, residual stenosis, lumen increase and late lumen loss of target lesions were observed in the two groups. At 6 and 12 months after surgery, major adverse cardiovascular events and bleeding events were followed up. This study was approved by the Medical Ethics Committee of Jiaozuo People’s Hospital, China (approval No. 201503).

    RESULTS AND CONCLUSION: (1) The success rate of surgery in the drug-coated balloon group was significantly higher than that in the drug-eluting group (P=0.028). (2) Immediately after surgery, the minimum lumen diameter and lumen increase in the drug-coated balloon group were less than those in the drug-eluting stent group (both P < 0.01). The residual stenosis in the drug-coated balloon group was significantly greater than that in the drug-eluting stent group (P < 0.01). (3) At 6 months after surgery, late lumen loss of target vessels in the drug-coated balloon group was smaller than that in the drug-eluting stent group (P < 0.001). The rates of target vessel revascularization and major adverse cardiovascular events in the drug-coated balloon group were lower than those in the drug-eluting stent group (P=0.028, 0.010). (4) At 12 months after surgery, the minimum lumen diameter in the drug-coated balloon group was larger than that in the drug-eluting stent group (P=0.033). The residual stenosis and late lumen loss in the drug-coated balloon group were lower than those in the drug-eluting stent group (P=0.008, 0.002, 0.019). (5) These results suggest that drug-coated balloon for treatment of type 2 diabetes mellitus complicated by coronary artery small vessel disease is simple and easy to operate, with a high surgical success rate. Drug-coated balloon can reduce residual stenosis degree and late lumen loss, decrease the revascularization rate of target vessels, and reduce the incidences of major adverse cardiovascular disease and bleeding events. The clinical prognosis of drug-coated balloon is superior to that of drug-eluting stent. 

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    Cardiac valve prosthesis implantation and surgical maze ablation for the treatment of valvular disease with atrial fibrillation

    Ma Chao, Wang Huishan, Han Jinsong, Yin Zongtao, Zhang Xiling
    2020, 24 (28):  4580-4587.  doi: 10.3969/j.issn.2095-4344.2317
    Abstract ( 452 )   PDF (37695KB) ( 32 )   Save

    BACKGROUND: Patients with mitral valve disease have a higher incidence of atrial fibrillation after mitral valve replacement and mitral annuloplasty. Maze surgery is the gold standard for surgical treatment of atrial fibrillation. The effect of artificial valve and valve ring on maze surgery is not clear.

    OBJECTIVE: To evaluate the changes of sinus rhythm-left atrial contractive function after surgical maze ablation of valvular atrial fibrillation and whether valve replacement or valve ring implantation affects the recovery of sinus rhythm-left atrial contractive function.

    METHODS: From October 2013 to October 2017, 324 patients who underwent surgical maze ablation due to mitral valve lesions associated with persistent or long-term persistent atrial fibrillation in the General Hospital of Northern Theater Command were enrolled. All patients were treated with artificial valve replacement or artificial valve ring implantation after maze operation. The patients were followed up by electrocardiogram and echocardiography at discharge and 1, 3, 6, 12 and 24 months after procedure. A multivariate Cox analysis of predictive factors for left atrial contractive function recuperation was applied. This study was approved by the Medical Ethics Committee of General Hospital of Northern Theater Command (original General Hospital of Shenyang Military Region of Chinese PLA).

    RESULTS AND CONCLUSION: (1) Two patients (0.6%) died during the perioperative period, and the remaining 322 patients were followed up for 2 years. There were no adverse events related to artificial materials during the follow-up. (2) The recovery rate of left atrial contractive function increased gradually after procedure. The coexistence consistency of left atrial contractive function and sinus rhythm was good until 1 year after surgery (Kappa coefficient ≥ 0.75, P < 0.05). Two years after maze procedure, the recovery rates of sinus rhythm and left atrial contractive function were 86.6% and 85.1%, respectively. (3) Cox multiple regression analysis showed that long duration of preoperative atrial fibrillation, large preoperative left atrial diameter, loss of left atrial contractive function 3 months after surgery, and cryoablation were the common predictors of sinus rhythm and left atrial contractive function recovery in the middle and late stages (> 3 months) after surgical maze ablation (all P values < 0.05). Long duration of preoperative atrial fibrillation, large preoperative left atrial diameter, incision and suture modes were the predictors of the recovery of left atrial systolic force (P < 0.05). Valvular replacement or valve ring implantation, material type and prosthesis pattern were not the factors that affect the recovery of atrial fibrillation and left atrial systolic force in the middle and late stages (P > 0.05). (4) ROC curve analysis showed that the optimal critical value of preoperative atrial fibrillation time and preoperative left atrial diameter for prediction of left arterial contractive function recovery was 36.5 months (sensitivity 90.5%, specificity 93.7%) and 60.5 mm (sensitivity 93.8%, specificity 85.0%) respectively. (5) These results suggest that the recovery of left atrial contractive function after surgical maze ablation is a dynamic improvement process. Early recovery of left atrial contractive function is beneficial to maintaining stable sinus rhythm in the future. Prolonged duration of atrial fibrillation, enlarged left atrial diameter, and cryoablation mode may have adverse effects on surgical maze ablation. Valve ring implantation or valvular replacement does not affect the efficacy of surgical maze ablation. 

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    Efficacy of 3D Max mesh versus common mesh for laparoscopic inguinal hernia repair
    Hou Haisheng, Yang Li, Yan Xiaowei
    2020, 24 (28):  4588-4592.  doi: 10.3969/j.issn.2095-4344.2311
    Abstract ( 652 )   PDF (22260KB) ( 108 )   Save

    BACKGROUND: In inguinal hernia repair, the choice of mesh based on the characteristics of a single piece of mesh remains controversial. The long-term outcome of hernia recurrence and mesh-specific complications need to be evaluated.  

    OBJECTIVE: To investigate the effects of 3D Max mesh versus common mesh for laparoscopic inguinal hernia repair on surgical outcomes and quality of life.

    METHODS: 142 patients with uncomplicated inguinal hernia who received treatment between February 2013 and January 2016 in Qinhuangdao Cerebrovascular Disease Hospital were included in this study. These patients consisted of 131 males and 11 females and were aged 18-60 years. They were randomly divided into a 3D Max mesh group (n=80) and ordinary mesh group (n=62) according to the mesh materials used. Surgical details and outcomes, recurrence rate, complications and hospitalization costs were recorded. Quality of life was evaluated before surgery, 2 weeks and 1, 6, 12 and 24 months after surgery using the Carolinas Comfort Scale. The study was approved by the Medical Ethics Committee of Qinhuangdao Cerebrovascular Disease Hospital, China (approval No. 2013-002-02).

    RESULTS AND CONCLUSION: (1) The operation time, time to ambulation, and hospitalization expense in the 3D Max mesh group were significantly reduced compared with the ordinary mesh group (P < 0.05). The incidence of seroma in the 3D Max mesh group was significantly lower than that in the ordinary mesh group (7.5%, 21.5%, P < 0.001). There were no significant differences in the incidences of hernia and other complications between 3D Max mesh and ordinary mesh groups (P > 0.05). (2) The pain sensation score in the 3D Max mesh group at 2 weeks and 1 month after surgery was significantly lower than that in the ordinary mesh group (P < 0.05). At 2 weeks and 1, 6, 12, and 24 months after surgery, there were no significant differences in total quality of life score, score of colic sensation, and motor limitation between 3D Max mesh and ordinary mesh groups (P > 0.05). (3) These results suggest that compared with ordinary mesh, 3D Max mesh can effectively shorten operation time, decrease hospitalization expense, and decrease the incidence of postoperative short-time chronic pain. 

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