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08 February 2022, Volume 26 Issue 4 Previous Issue    Next Issue

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Application of degradable high-purity magnesium screw in the treatment of developmental dysplasia of the hip Huang Shibo, Xie Hui, Wang Zongpu, Wang Weidan, Qin Kairong, Zhao Dewei 2022, 26 (4):  493-498.  doi: 10.12307/2022.081 Abstract ( 501 )   PDF (1552KB) ( 286 )   Save BACKGROUND: In the selection of total hip arthroplasty for acetabular defect patients with developmental dysplasia of the hip, the management of the acetabular side is very important for the placement of the prosthesis. The external and upper acetabular bone grafting has been proven to be a safe and feasible treatment method, and how to carry out the bone grafting has become the key factor for the success of the operation. OBJECTIVE: To investigate the clinical effect of external and superior acetabular bone graft combined with total hip arthroplasty in the treatment of acetabular defect in patients with developmental dysplasia of the hip and fixation of bone graft with degradable high-purity magnesium metal screws. METHODS: Seven cases of developmental dysplasia of the hip acetabulum defect patients, with 1 male and 6 females, aged 54-65 years, were included from the Affiliated Zhongshan Hospital of Dalian University. According to Crowe type, there were 2 cases of I type, 1 case of II type, 2 cases of III type, and 2 cases of IV type. All cases underwent artificial total hip arthroplasty. The acetabulum received external and upper acetabular bone grafting and the coverage. The bone grafts were fixed with biodegradable high-purity magnesium metal screw. The imaging examination, Harris hip functional score and visual analogue scale score were performed in the postoperative follow-up. This study was approved by the Ethics Committee of the Affiliated Zhongshan Hospital of Dalian University (approval No. 2013-006). RESULTS AND CONCLUSION: (1) Seven patients were followed up for 2-4.5 years. The shortened affected limb decreased from (2.43±0.78) cm preoperatively to (0.57±0.56) cm postoperatively. No incision infection or nonunion was observed, and no periprosthetic infection was observed. (2) The visual analogue scale score at the last follow-up was lower than that before surgery in seven patients (P < 0.05). Harris score of hip function was higher than that before surgery (P < 0.05). (3) Imaging examination showed that all the degradable high-purity magnesium metal screws were degraded three or four years after surgery, and the graft bone healed with the acetabular bone. No graft loss or prosthesis loosening was observed. No postoperative adverse complications were observed in all cases. (4) The results showed that for the patients with acetabular defect with developmental dysplasia of the hip, the treatment with degradable high-purity magnesium metal screw fixation and total hip arthroplasty on the external and upper part of the acetabulum was satisfactory in the short term. Figures and Tables | References | Related Articles | Metrics

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Diffuse distribution of bone cement in percutaneous vertebroplasty reduces the incidence of refracture of adjacent vertebral bodies Shen Song, Xu Bin 2022, 26 (4):  499-503.  doi: 10.12307/2022.082 Abstract ( 604 )   PDF (776KB) ( 197 )   Save BACKGROUND: Percutaneous vertebroplasty is one of the effective treatments for osteoporotic vertebral compression fractures. The distribution of bone cement in the vertebral body will influence the clinical efficacy. OBJECTIVE: To investigate the influence of the distribution of bone cement in percutaneous vertebroplasty on the early postoperative outcomes after osteoporotic vertebral compression fractures.  METHODS: A total of 132 patients, including 52 males and 80 females, with a mean age of (76.3±8.2) years who diagnosed as osteoporotic vertebral compression fractures in First Hospital of Shanxi Medical University from January 2017 to June 2019 were enrolled. All patients were divided into underdispersion group (n=54) and diffuse distribution group (n=78) according to the pattern of cement distribution on postoperative X-rays. Visual analogue scale scores postoperatively, the height of anterior edge and midline of injured vertebrae, Cobb angle of local kyphosis and the incidence of complications after 1-year follow-up were compared between the two groups. The trial was performed in accordance with the relevant ethical requirements for research in the First Hospital of Shanxi Medical University.  RESULTS AND CONCLUSION: (1) The visual analogue scale scores were lower at 2 days, 1 and 6 months after operation than those before operation in the two groups (P < 0.05). The visual analogue scale scores at 1 month after operation in the underdispersion group were higher than those in the diffuse distribution group (P < 0.05), and there was no significant difference between the two groups at 2 days and 6 months after operation (P > 0.05). (2) Cobb angle and vertebral body height improved in both groups postoperatively compared to preoperatively (P < 0.05). The difference in Cobb angle and vertebral body height was not statistically significant between the two groups (P > 0.05). (3) The rate of bone cement infiltration was not significantly different between the two groups (P > 0.05). Incidence of recurrent fractures in adjacent vertebrae was lower in the diffuse distribution group than that in the underdispersion group (P < 0.05). (4) These findings confirm that percutaneous vertebroplasty is an effective treatment for osteoporotic vertebral compression fractures. The distribution of bone cement in the vertebral body will affect the surgical results. The bone cement is diffusely distributed, which may reduce the incidence of recurrent fractures in adjacent vertebrae. Figures and Tables | References | Related Articles | Metrics

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Correlation between preoperative magnetic resonance imaging findings and bone cement leakage after percutaneous vertebral augmentation Hou Wanxing, Li Hongwei, Zheng Xin, Zhu Xianren 2022, 26 (4):  504-509.  doi: 10.12307/2022.083 Abstract ( 481 )   PDF (921KB) ( 228 )   Save BACKGROUND: Studies have shown that the endplate injuries in patients with osteoporotic vertebral compression fracture are related to the intradiscal cement leakage after percutaneous vertebral augmentation. OBJECTIVE: To investigate the correlation between preoperative magnetic resonance imaging findings and intradiscal cement leakage after percutaneous vertebral augmentation, and to analyze whether endplate fractures and adjacent intervertebral disc injuries affect the incidence of intradiscal cement leakage.  METHODS: Totally 182 patients with single-level osteoporotic vertebral compression fractures admitted to the Affiliated Hospital of Xuzhou Medical University from September 2018 to December 2019 were selected, of which 110 received percutaneous kyphoplasty treatment, 72 cases received percutaneous vertebroplasty treatment. According to the preoperative magnetic resonance imaging images, the condition of the adjacent intervertebral disc injury and endplate fracture of the fractured vertebral body was evaluated. According to whether there is intradiscal cement leakage after the operation, the patients were divided into a leakage group (n=32) and a non-leakage group (n=150). A univariate analysis was performed on the correlation between the patient’s age, gender, surgical spinal level, surgical method, endplate fracture, adjacent intervertebral disc injury and intradiscal cement leakage, and then a multivariate binary logistics regression model analysis was performed. The study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University. RESULTS AND CONCLUSION: (1) Of the 182 patients, 63 had endplate fractures and 98 had adjacent intervertebral disc injuries. In all patients, 32 cases of intradiscal cement leakage occurred after percutaneous vertebral augmentation; the leakage rate of the endplate fracture group was higher than that of the non-endplate fracture group (P < 0.05), and the leakage rate of the intervertebral disc injury group was higher than that of the non-intervertebral disc injury group (P < 0.05). (2) The results of univariate analysis showed that intradiscal cement leakage was related to surgical method (P < 0.05), which was not related to age, gender, and surgical spinal level (P > 0.05). (3) The binary logistics regression analysis showed that the endplate fracture was the independent risk factor for intradiscal cement leakage after percutaneous vertebral augmentation; adjacent intervertebral disc injury, age, gender, surgical method, and surgical spinal level were not the risk factors for intradiscal cement leakage. (4) Related analysis showed that there was a significant correlation between the endplate fracture and the intervertebral disc injury (r=0.47, P=0.000). (5) The results showed that the endplate fracture found in the preoperative magnetic resonance imaging was a risk factor for intradiscal cement leakage, and the intervertebral disc injury was not the influence factor of intradiscal cement leakage; the intervertebral disc injury was significantly related to the endplate fracture in osteoporotic vertebral compression fractures patients. Figures and Tables | References | Related Articles | Metrics

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Transplantation of umbilical cord mesenchymal stem cells encapsulated in RADA16-BDNF hydrogel promotes neurological recovery in an intracerebral hemorrhage rat model Huang Chuanjun, Zou Yu, Zhou Xiaoting, Zhu Yangqing, Qian Wei, Zhang Wei, Liu Xing 2022, 26 (4):  510-515.  doi: 10.12307/2022.084 Abstract ( 2077 )   PDF (847KB) ( 255 )   Save BACKGROUND: Brain-derived neurotrophic factor (BDNF) plays an important role in inducing neural differentiation of mesenchymal stem cells and protecting the survival of endogenous neurons. In our previous study, we constructed the polypeptide hydrogel scaffold, RADA16-BDNF and proved it possess excellent cellular and brain tissue compatibility. The BDNF released from RADA16-BDNF hydrogel may benefit for neural differentiation of mesenchymal stem cells.  OBJECTIVE: To observe the effect and potential mechanism of transplantation of RADA16-BDNF hydrogel scaffold with mesenchymal stem cells encapsulated for neuronal regeneration and neurological recovery in cerebral hemorrhage rat model.  METHODS: (1) Atomic force microscope and scanning electron microscope analysis were conducted to observe the surface structure of RADA16-BDNF hydrogel scaffold with or without umbilical cord mesenchymal stem cells. (2) RADA16-BDNF hydrogel with umbilical cord mesenchymal stem cells encapsulated was cultured in vitro, and single umbilical cord mesenchymal stem cell was used as control. Immunofluorescence staining was conducted to detect the expression of Ki-67 and β-Tubulin III and cell morphology. (3) The cerebral hemorrhage rat models were conducted by autologous blood stereotactic injection. RADA16-BDNF polypeptide hydrogel or PBS (100 µL) with umbilical cord mesenchymal stem cells (PKH26 labeled) was injected directionally. The escape time was detected by water maze test at different time after transplantation, and the recovery of neurological function was evaluated. Microtubule-associated protein 2 was detected by immunofluorescence staining 60 days later. RESULTS AND CONCLUSION: (1) RADA16-BDNF hydrogel scaffold possessed the micro-pore structure and the pores provided a space for adherence and survival for encapsulated cells. (2) RADA16-BDNF hydrogel scaffold promoted the proliferation and neuronal differentiation of umbilical cord mesenchymal stem cells in vitro (P < 0.05), and the micro-pore structure promoted the extension of nerve dendrites. (3) RADA16-BDNF hydrogel scaffolds can promote the umbilical cord mesenchymal stem cells to survive and differentiate into neurons in the rat brain and improve the recovery of neurological function. Figures and Tables | References | Related Articles | Metrics

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Biodentine enhances the proliferation and differentiation of osteoblasts through upregulating bone morphogenetic protein-2 Yang Sidi, Wang Qian, Xu Nuo, Wang Ronghan, Jin Chuanqi, Lu Ying, Dong Ming 2022, 26 (4):  516-520.  doi: 10.12307/2022.085 Abstract ( 502 )   PDF (28733KB) ( 139 )   Save BACKGROUND: Biodentine is a new kind of biocompatible calcium silicate dental restoration material. It can not only increase the secretion of growth factors in dental pulp cells, but also induce the mineralization of dentin. However, the research of Biodentine in bone repair is few. OBJECTIVE: To investigate the effects of Biodentine on the proliferation and differentiation of bone morphogenetic protein-2 interfered mouse osteoblast precursor cell lines by constructing mouse osteoblast precursor cell lines in which bone morphogenetic protein-2 was interfered.  METHODS: The 0.1, 1, 10, and 100 g/L Biodentine extract was applied to mouse osteoblast precursor cells for 24 hours. The optimal concentration of 10 g/L was selected by CCK-8 and alkaline phosphatase for the following experiments. Biodentine extract was used to treat mouse osteoblast precursor cells for 1, 3, 5 and 7 days, and the non-intervention group was used as the control group. The cell proliferation and osteogenic differentiation were observed by CCK-8 assay and alkaline phosphatase activity test. Mouse osteoblast precursor cell lines were constructed by interfering with bone morphogenetic protein-2. The proliferation and osteogenic differentiation of cells were observed by CCK-8 assay and alkaline phosphatase activity test. The mouse osteoblast precursor cell lines interfering with bone morphogenetic protein-2 were constructed. The Biodentine group was added with 10 g/L Biodentine extract, and the non-intervention group was set as the control. After 24 and 48 hours of treatment, the proliferation and osteogenic differentiation of the cells were observed by CCK-8 assay and alkaline phosphatase activity test. After 24 hours of treatment, the expression levels of alkaline phosphatase mRNA and protein were detected by real-time PCR and western blot assay.  RESULTS AND CONCLUSION: (1) 10 g/L Biodentine extract could promote the proliferation and osteogenic differentiation of mouse osteoblast progenitor cells at 1, 3, 5 and 7 days. (2) Interfering with bone morphogenetic protein-2 could inhibit the proliferation and osteogenic differentiation of mouse osteoblast progenitor cells. (3) The cell proliferation and osteogenic differentiation abilities of Biodentine group were higher than those of control group at 24 and 48 hours (P < 0.05), and the expression levels of alkaline phosphatase mRNA and protein of Biodentine group were higher than those of the control group (P < 0.05). (4) The results showed that 10 g/L Biodentine could enhance the proliferation and osteogenic differentiation of osteoblasts through bone morphogenetic protein-2. Figures and Tables | References | Related Articles | Metrics

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Biosafety evaluation of three-dimensional printed gelatin/sodium alginate/58S bioactive glass scaffolds for bone defect repair Tan Guozhong, Tu Xinran, Guo Liyang, Zhong Jialin, Zhang Yang, Jiang Qianzhou 2022, 26 (4):  521-527.  doi: 10.12307/2022.086 Abstract ( 746 )   PDF (1500KB) ( 218 )   Save BACKGROUND: Among the biological materials developed by tissue engineering, gelatin, sodium alginate and 58S bioactive glass have good biocompatibility, suitable degradability and better osteogenic induction in bone defect repair.   OBJECTIVE: To prepare gelatin/sodium alginate/58S bioactive glass scaffolds with three-dimensional printing technology and investigate their performance in vitro and biosafety. METHODS:  Gelatin, sodium alginate and 58S bioactive glass were mixed with deionized water and stirred uniformly as printing ink. The scaffolds were prepared by three-dimensional printing technology and then lyophilized after cross-linking. (1) In vitro experiment: The morphological characteristics and compressive strength of the scaffolds were detected by scanning electron microscopy and universal material testing machine, respectively. The scaffolds were immersed into simulated body fluid for 16 weeks to observe the degradation rate. L929 cells were cultured with scaffold extract for 3 days, and the morphology and growth of cells were observed. The scaffolds were co-cultured with rat bone marrow mesenchymal stem cells for 0, 7, 14 and 21 days. The cell proliferation was detected by CCK-8 assay. The cell adhesion and survival were observed by DAPI staining. The expression of osteogenic related genes was detected by RT-PCR. (2) In vivo experiment: Full thickness bone defects with a diameter of 5 mm were made in the right mandibles of 10 SD rats; 5 in the experimental group were implanted with scaffolds, and 5 in the blank control group were not implanted with scaffolds. Liver and kidney function tests and histological staining of the liver, kidney, brain and bone defects were performed 4 weeks after surgery.   RESULTS AND CONCLUSION: (1) In vitro experiment: Scanning electron microscopy showed that the surfaces of the scaffolds were rough and honeycombed. The average Young’s modulus of the scaffolds was 272.33 MPa. In the first 6 weeks, the scaffolds degraded rapidly and uniformly after soaking in the simulated body fluids. After the week 6, the degradation rate slowed down and remained roughly uniform, and the degradation rate reached 18% at the week 16. Inverted microscope showed that L929 cells grew well in the scaffold extract, and the morphology and structure of L929 cells were intact. With the extension of culture time, the proliferation rate of rat bone marrow mesenchymal stem cells increased. DAPI staining showed that the rat bone marrow mesenchymal stem cells adhered to the surfaces of the scaffolds and gradually crawled and expanded from initial accumulation to peripheral growth. RT-PCR assay revealed that the scaffolds could promote the mRNA expression of bone morphogenetic protein-2, osteocalcin and RUNX2 in rat bone marrow mesenchymal stem cells. (2) In vivo experiment: In the experimental group, the function of liver and kidney was not affected, and pathological damage of liver, kidney and brain tissue was not caused after implantation of scaffolds. Hematoxylin-eosin staining of the mandibular bone defect specimens indicated that the scaffolds of the experimental group were not completely degraded, and the new bone connected the host bone with the remaining scaffolds. A small amount of osteoblasts and inflammatory cells were observed around the new bone tissue, while a small amount of new bone and a large amount of fibrous tissue were seen at the edge of the host bone in the blank control group. (3) These results suggested that the three-dimensional printed gelatin/sodium alginate/58S bioactive glass scaffolds for bone defect repair possess favorable cytocompatibility, no obvious cytotoxicity or tissue toxicity, and have admirable biosafety. Figures and Tables | References | Related Articles | Metrics

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Preparation and in vitro evaluation of vancomycin hydrochloride@polylactic acid-glycolic acid copolymer-chitosan-hyaluronic acid composite sustained-release microspheres Le Guoping, Zhang Ming, Xi Licheng, Luo Hanwen 2022, 26 (4):  528-534.  doi: 10.12307/2022.087 Abstract ( 658 )   PDF (818KB) ( 350 )   Save BACKGROUND: Local antibiotic slow-release system can solve the problems of total toxicity caused by systemic antibiotics and short half-life of short-term local antibiotics.   OBJECTIVE: To prepare polylactic acid-glycolic acid copolymer-chitosan-hyaluronic acid composite sustained-release microspheres loaded with vancomycin and evaluate its performance. METHODS:  Vancomycin-loaded polylactic acid-glycolic acid copolymer-chitosan-hyaluronic acid composite sustained-release microspheres and unloaded polylactic acid-glycolic acid copolymer-chitosan-hyaluronic acid composite microspheres were prepared by emulsion method. Mass concentrations of vancomycin in the drug-loaded microspheres were 25, 50, and 100 g/L. The drug-loading amount, encapsulation efficiency, and in vitro sustained release properties of the drug-loaded microspheres were detected. The three kinds of drug-loaded microspheres were co-cultured with Staphylococcus aureus bacteria separately, and the antibacterial rate was detected within the corresponding time points. The four kinds of microsphere extracts were co-cultured with MC3T3-E1 cells and MG-63 cells, and the cytotoxicity was detected by CCK-8 method after 1, 3, and 7 days of culture.   RESULTS AND CONCLUSION: (1) The encapsulation efficiencies of 25, 50, and 100 g/L drug-loaded microspheres were (79.70±5.11)%, (86.41±3.91)%, and (63.18±1.96)%, and the drug loading was (3.98±0.26)%, (8.64±0.39)%, and (12.63±0.39)%. The encapsulation efficiency of 50 g/L drug-loaded microspheres was higher than that of 100 g/L drug-loaded microspheres (P < 0.05). The drug loading of 100 g/L drug-loaded microspheres was higher than that of the other two groups (P < 0.05). (2) Three kinds of drug-loaded microspheres had no obvious burst release within 24 hours, of which the drug release rate of 50 g/L drug-loaded microspheres at different time points was faster than that of the other two groups. The drug release amount of 100 g/L drug-loaded microspheres at different time points was higher than that of the other two groups, and the drug mass concentration of the three groups was higher than minimum antibacterial concentration of vancomycin at 56 days. (3) All three kinds of drug-loaded microspheres could effectively kill Staphylococcus aureus within a certain period of time. From 14 to 28 days, the relative colony rate of the three kinds of microspheres was lower than 3%, indicating that three kinds of drug-loaded microspheres can continuously and effectively kill Staphylococcus aureus. (4) The 25 and 50 g/L drug-loaded microspheres have no obvious cytotoxicity to MC3T3-E1 cells and MG-63 cells, and 100 g/L drug-loaded microspheres have certain cytotoxicity. (5) The results show that the VA@PLGA-CS-HA microspheres have good sustained-release performance, antibacterial ability and biological tissue compatibility. Figures and Tables | References | Related Articles | Metrics

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Optimization of preparation method of atorvastatin calcium sustained-release microspheres Liu Tongbin, Lin Peng, Zhang Xiaoming, Dong Xiling, Cao Fei, Wang Le, Guo Xinxing 2022, 26 (4):  535-539.  doi: 10.12307/2022.088 Abstract ( 657 )   PDF (819KB) ( 400 )   Save BACKGROUND: In recent years, studies have found that statins have significant effects on regulating bone metabolism, repairing bone microstructure, inhibiting inflammation, promoting cell proliferation, repairing vascular endothelium, and regulating signal pathway conduction.  OBJECTIVE: To optimize the preparation parameters of atorvastatin calcium sustained-release microspheres, to prepare sustained-release microspheres with large drug loading and regular morphology.  METHODS: The bovine serum albumin sustained-release microspheres loaded with atorvastatin calcium were prepared by desolvent method. The main factors affected the preparation of the microspheres were screened out. The four key related factors were bovine serum albumin concentration (40, 70, 100 g/L), pH value (7, 8, 9), dosage of atorvastatin calcium (200, 300, 400 µg), and ethanol addition rate (0.2, 0.5, 1 mL/min). The optimal preparation conditions of large drug loading were screened by orthogonal test. Atorvastatin calcium-loaded bovine serum albumin sustained-release microspheres were prepared under optimal parameters and placed in PBS for sustained-release performance testing. RESULTS AND CONCLUSION: (1) The optimum preparation parameters were as follows. The concentration of bovine serum albumin was 100 g/L; the pH value was 7; the dosage of atorvastatin calcium was 400 µg; the addition rate of ethanol was 0.2 mL/min. (2) The microspheres prepared under this parameter had regular morphology and smooth surface. The particle size was (425.0±13.8) nm and the encapsulation efficiency of drug loaded microspheres was up to 85.70%. The in vitro release time could last for more than 48 hours, and the cumulative release reached 73% which had a relatively good sustained release effect. (3) It is indicated that the stable sustained-release microspheres loaded with atorvastatin calcium were successfully prepared. The sustained-release microspheres with high drug loading and stability can achieve sustained drug release. Figures and Tables | References | Related Articles | Metrics

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Comparison of oral micro-adhesion on polyetheretherketone, zirconium dioxide, and pure titanium abutment Qiu Peng, Fu Qilin, Liu Min, Lan Yuyan, Wang Pin 2022, 26 (4):  540-545.  doi: 10.12307/2022.089 Abstract ( 589 )   PDF (992KB) ( 280 )   Save BACKGROUND: There are some aesthetic and biomechanical problems in the application of zirconium dioxide and pure titanium abutment in the anterior teeth area. A kind of aesthetic abutment material conforming to biomechanics needs to be studied urgently. OBJECTIVE: To compare the adhesion of Porphyromonas gingivalis and whole saliva on the surface of polyetheretherketone (PEEK), zirconium dioxide (ZrO2), and pure titanium (Ti).  METHODS: Specimens with the shape of a disk were prepared from PEEK, ZrO2, and Ti. The surface morphology feature was observed by scanning electron microscope. Surface roughness was determined by atomic force microscope. Contact angle was measured using contact angle measuring instrument. The adhesion force of Porphyromonas gingivalis on the surface of materials was measured using an atomic force microscope probe. The initial bacterial adhesion on materials in the suspension of Porphyromonas gingivalis and whole saliva was evaluated by scanning electron microscope and Cell Counting Kit-8 assay.  RESULTS AND CONCLUSION: (1) Scanning electron microscope showed that the surface of the PEEK and Ti specimen was grooved, and the groove of PEEK was more than that of Ti, and there were a few microholes on the surface of ZrO2. Atomic force microscopy showed that parallel groove undulations were observed on the surfaces of the three specimens. The groove peak and valley structure of PEEK and ZrO2 was more prominent than that of Ti, and the porous concave and convex structure of the ZrO2 surface was more than that of PEEK. (2) The surface roughness of ZrO2 was greater than that of Ti (P < 0.05). The pairwise comparison between other groups showed no significant difference (P > 0.05). There was no significant difference between the contact angles of the three groups (P > 0.05). (3) A significantly lower adhesion force was identified for PEEK than for ZrO2 and Ti (P < 0.05). (4) The results of scanning electron microscope observation showed that the bacterial adhesion on the PEEK surface was the least, while that on the Ti surface was the most. The Cell Counting Kit-8 assay result showed that the initial bacterial adhesion on the surface of PEEK was significantly lower than that on the surface of ZrO2 and Ti (P < 0.05). (5) The results suggest that PEEK has more advantages to inhibit initial bacterial adhesion than conventional abutment materials such as ZrO2 and Ti.   Figures and Tables | References | Related Articles | Metrics

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Preparation and characterization of tantalum functional coating on titanium implant Chen Shuo, Xiao Dongqin, Li Xingping, Ran Bin, Shi Feng, Zhang Chengdong, Deng Li, Huang Nanxiang, Liu Kang, Feng Gang, Duan Ke 2022, 26 (4):  546-552.  doi: 10.12307/2022.090 Abstract ( 572 )   PDF (1321KB) ( 168 )   Save BACKGROUND: Titanium (Ti) alloy is widely used in clinical orthopedics, because of its good biocompatibility. However, as a biological inert material, it is lack of osteoinductive activity, which is easy to cause implant loosening. Therefore, it is necessary to modify the surface of titanium implant for enhancing its osteogenic activity. OBJECTIVE: To prepare Tantalum (Ta) functional coating on titanium surface by sol-gel method, and characterize the physicochemical properties and osteogenic properties of the coating. METHODS: Ta functional coating was prepared on the surface of medical Ti sheet by sol-gel method (named as Ti-Ta). The surface morphology and element composition of the coatings were characterized by scanning electron microscope and energy spectrum analysis. The surface hydrophilicity of Ti sheet, Ta sheet, and Ti-Ta coatings was evaluated by contact angle test. Rabbit bone marrow mesenchymal stem cells were co-cultured with the Ti, Ta and Ti-Ta samples. Cell adhesion morphology on the material surface was observed by scanning electron microscope. Cell adhesion and survival were observed by fluorescence staining. Cell proliferation activity was detected by CCK-8 method. Alkaline phosphatase staining and alizarin red S staining were used to evaluate the osteogenic differentiation ability of cells on the material surface. RESULTS AND CONCLUSION: (1) Scanning electron microscope images showed that nanoparticles were uniformly distributed on the surface of Ti-Ta sample and no cracks appeared. The elemental analysis showed that elements on the coating were mainly composed of Ta, O, Ti. Ti-Ta surface had better hydrophilicity than that of Ti and Ta. (2) Twelve hours after seeding, cells spread and adhered to the surface of Ti-Ta, protruding a large number of filamentous pseudopodia to the distance and connecting with adjacent cells. For cells on the surface of Ti and Ta, they showed long fusiform shapes, with a small amount of filamentous pseudopodia extending around. (3) The fluorescence staining results of living/dead cells showed that at 72 hours after seeding, a large number of living cells were observed on all surfaces. The number of adherent cells was more than that of Ti sheet and Ta sheet, and the number of living cells on the surface of Ti-Ta coating was more than that on Ti sheet and Ta sheet (P < 0.05). (4) CCK-8 results showed that Ti-Ta had the strongest ability to promote cell proliferation                (P < 0.05). (5) The content of alkaline phosphatase and the number of calcium nodules on the surface of Ti-Ta surfaces were much higher than those on the Ti and Ta surfaces. (6) In conclusion, the Ti surface modified by Ta coating was more favorable for the adhesion and osteogenic differentiation of bone marrow mesenchymal stem cells. Figures and Tables | References | Related Articles | Metrics

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Method of constructing cell spheroids based on agarose and polyacrylic molds He Yunying, Li Lingjie, Zhang Shuqi, Li Yuzhou, Yang Sheng, Ji Ping 2022, 26 (4):  553-559.  doi: 10.12307/2022.091 Abstract ( 870 )   PDF (1479KB) ( 304 )   Save BACKGROUND: The application prospect of cell spheroids is wide in tissue engineering, while the experimental cost of using commercial ultra-low adsorption culture plates to form spheroids is relatively high. Therefore, it is necessary to explore an alternative strategy for cell spheroids formation to promote the application of cell spheroids in related research fields. OBJECTIVE: Combined with agarose and polyacrylic mold, three-dimensional cell spheroids are established by layer-by-layer self-assembly technology, and so that the micro physiological environment of cells are partially restored. METHODS: In vitro, MC3T3-E1 cells of mice were coated with gelatin and sodium alginate respectively, through layer-by-layer self-assembly technology (LBL-MC3T3-E1). Gelatin-coated and sodium alginate-coated MC3T3-E1 cells were prepared as well. Agarose-coated plates and agarose microwell plates were prepared respectively. The cellular spheroids formation effect of the above treated cells in these culture plates was observed. The Live/Dead staining method was used to detect the viability of cell spheroids. The alkaline phosphatase staining and real-time PCR were used to confirm the osteogenesis of cell spheroids.  RESULTS AND CONCLUSION: (1) As seen under the light microscope, in agarose-coated well plates, both untreated and treated MC3T3-E1 cells did not form into spheroids; and in agarose microwell plates, untreated and LBL-MC3T3-E1 cells formed ideal cell spheroids, in which the diameter of LBL-MC3T3-E1 cell spheroids was larger than that of untreated MC3T3-E1 cell spheroids (P < 0.05). (2) The results of Live/Dead staining showed that the cellular viability within LBL-MC3T3-E1 cell spheroids was better than that of MC3T3-E1 cell spheroids (P < 0.05). (3) The alkaline phosphatase activity of LBL-MC3T3-E1 cell spheroids was higher than that of MC3T3-E1 cell spheroids (P < 0.05). Collagen-I and Osterix gene expression levels were higher than those of MC3T3-E1 cell spheroids (P < 0.05), and the difference in Runt-related transcription factor 2 gene expression was not significant between the two groups (P > 0.05). (4) These results showed that a three-dimensional culture model of cell spheroids was successfully established by using agarose and polyacrylic acid molds combined with layer-by-layer self-assembly technology. This method is convenient, economical, efficient, and has good cell viability, preserves the osteogenic differentiation ability of cells, thus having potential applications in the field of bone tissue engineering and regenerative medicine. Figures and Tables | References | Related Articles | Metrics

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Biomimetic orientated microchannel annulus fibrosus scaffold constructed by silk fibroin He Guanyu, Xu Baoshan, Du Lilong, Zhang Tongxing, Huo Zhenxin, Shen Li 2022, 26 (4):  560-566.  doi: 10.12307/2022.092 Abstract ( 512 )   PDF (1415KB) ( 238 )   Save BACKGROUND: The annulus fibrosus is an important part of the intervertebral disc, and is the key to maintain the mechanical and physiological functions of the intervertebral disc. Therefore, the construction of a biological scaffold that mimics the structure of the natural annulus fibrosus is essential for tissue engineering to repair the intervertebral disc. OBJECTIVE: To construct biomimetic orientated microchannel and control scaffold with silk fibroin as raw material, and to evaluate its feasibility as a tissue engineered annulus fibrosus scaffold.  METHODS: The polycaprolactone was used as raw material to construct 60° oriented fiber pattern by melt spinning technology, and filled with 15% silk fibroin solution, quick-freeze with liquid nitrogen, freeze-drying by lyophilizer. Polycaprolactone material was eluted by chloroform. The preparation of the orientated microchannel fibrous ring scaffold was completed; at the same time, a common silk fibroin scaffold was prepared as a control. The microscopic morphology and mechanical properties of the scaffold were characterized. The third-generation rabbit annulus cells were inoculated on the two scaffolds respectively. The viability and proliferation ability of the cells on the scaffold were analyzed by Live/Dead staining and CCK-8 assay. The two scaffolds were implanted subcutaneously in rats, and the scaffolds were removed 4 weeks later for hematoxylin-eosin staining. RESULTS AND CONCLUSION: (1) Stereoscopic microscope and scanning electron microscope showed that there were a large number of regular channels arranged on the surface of the oriented microchannel scaffold and the channels penetrated deeply into the scaffold, and there were only a few cracks on the surface of the control scaffold. The diameter of two kinds of scaffolds was (152.0±9.3) μm. The porosity was (89.0±3.3)% in the oriented microchannel  group and (73.0±2.6)% in the control group. (2) The compression elastic modulus was (2.65±0.11) MPa in oriented microchannel group and (3.05±0.13) MPa in the control group (P < 0.05). (3) The Live/Dead staining and scanning electron microscope results showed that cells grow well on both scaffolds. In the control group, the scaffold cells only attached to the scaffold surface. The cells grew into the scaffolds along the microchannels and the extracellular matrix was secreted sufficiently. CCK-8 assay showed that the oriented microchannel scaffolds could promote cell proliferation. (4) Hematoxylin-eosin staining revealed that a lot of extracellular matrix components and cells were found in the oriented microchannel scaffolds. In the control group, a lot of cells and extracellular matrix only grew on surface of scaffold. (5) It is concluded that the oriented microchannel silk fibroin scaffold can simulate natural annulus fibrosus microstructure, which have good mechanical property; and the cells can along the channel grow into the scaffold, which has good biocompatibility. It is a suitable biological scaffold for the construction of annulus fibrosus scaffold. Figures and Tables | References | Related Articles | Metrics

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Stress analysis of maxillary central incisor crown implant restoration in different occlusal modes Baibujiafu·Yelisi, Renaguli·Maihemuti, Aizimaitijiang·Saiyiti, Wang Junxiang, Nijiati·Tuerxun 2022, 26 (4):  567-572.  doi: 10.12307/2022.093 Abstract ( 537 )   PDF (784KB) ( 342 )   Save BACKGROUND: In the treatment of oral implant repair, different occlusal contact methods affect the internal structure of the implant and the stress distribution in the bone tissue. Whether the stress distribution is balanced or not determines the long-term life of the implant and the stability of the surrounding bone level.   OBJECTIVE: To explore the effects of different occlusal contact modes on the internal stress distribution of restoration, implant, abutment, retention screw, bone tissue, binder and restoration in three kinds of occlusal relationship of maxillary central incisor implant. METHODS:  The cone beam CT image data of one volunteer undergoing implant restoration of the maxillary central incisor were extracted from the database. Mimics 19.0 software was utilized to build the maxillary model, and the maxillary model was imported into Solidworks 2017 software to build the maxillary central incisor crown restoration model. Using ANSYS Workbench 17.0 software, three occlusal contact modes of end-to-end occlusion, normal occlusion, and deep overbite occlusion were loaded by simulating the distal middle edge of the crown, the midpoint of the implant diameter and the midpoint of the joint crown. The stress distribution of each structure and bone tissue in the implant restoration was analyzed under the influence of three kinds of occlusal relationship and three loading modes.   RESULTS AND CONCLUSION: (1) In the end-to-end occlusion group, when the contact mode changed from the distal margin to the midpoint of the implant diameter and the midpoint of the crown, the stress of the internal structure, bone tissue and binder of the implant decreased accordingly. (2) In the normal group, when the contact mode changed from the distal margin to the midpoint of the implant diameter and the midpoint of the joint crown, the stress of the internal structure, bone tissue and binder of the implant decreased accordingly. (3) In the deep overbite group, when the contact mode changed from the distal margin to the midpoint of the implant diameter and the midpoint of the crown, the stress of the internal structure and bone tissue of the implant increased accordingly, while the stress of the binder gradually increased. (4) The results show that different occlusal contact modes and occlusal relationship affect the distribution of stress in each structure, bone tissue and binder of implant restoration. This conclusion may provide a reference basis for the adjustment of occlusal contact of implant restoration. Figures and Tables | References | Related Articles | Metrics

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Finite element analysis of the influence of different implant designs on the stress of mandibular edentulous jaw Wang Can, Gu Weiping, Jiang Yubin, Zhu Lin, Chen Gang 2022, 26 (4):  573-578.  doi: 10.12307/2022.094 Abstract ( 590 )   PDF (657KB) ( 662 )   Save BACKGROUND: The implant fixed complete denture for mandibular edentulous jaws has become one of the main clinical restoration methods. Mechanical studies on different implant designs can help clinical selection of implant designs in line with biomechanical principles, which is beneficial to maintain the long-term stability of implant dentures. OBJECTIVE: To establish the models for the distribution of different implant sites with the same cantilever length, and to analyze the influence of implant sites, the symmetry of implant distribution and the number of implants on the stress distribution around the abutment, implant, and bone tissue. METHODS: Cone beam CT data of an edentulous mandible were selected. The cone beam CT data, implant, abutment, and crown restoration data were used to create finite element model of different transplantation sites and regions, and different number of implants. The premolars and molars regions were bilaterally subjected to a vertical load of 150 N. The software was used to calculate the stress of the abutment, implant, and bone tissue, and then statistical analysis was performed. RESULTS AND CONCLUSION: (1) When the frontmost implant was closer to the front, the stress on the abutment, implant and bone tissue would gradually decrease. For four implants, when the number of implants located at and before the lateral incisor was 2, the bone tissue stress value was the smallest, and there was a statistical difference in the stress value with 1 and 0 implants (P < 0.05). For five implants, when the frontmost implant site was located at and before the lateral incisor, there was a statistical difference in the stress value with the canine and later (P < 0.05). Therefore, when the length of the cantilever was fixed (10 mm in the experiment), the foremost implant of 4 or 5 implants should be placed in the lateral incisor and the front site. When there were four implants, the number 2 of implants before the lateral incisor was a better choice (2) When the cantilever length and anterior-posterior spread (the distance between the frontmost implant and the two farthest implants) remained unchanged. The symmetry of the model had no statistical difference in the stress distribution around the abutment, implant and bone tissue (P > 0.05). Therefore, the implants were not arranged in accordance with the principle of symmetry when the cantilever length and anterior-posterior spread remained unchanged. (3) When the number of implants was four, the stress around abutment and implant was significantly larger, and the difference in stress was statistically significant with five and six implants (P < 0.05). Therefore, five or more implants are better for the implant fixed complete denture. Figures and Tables | References | Related Articles | Metrics

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Effectiveness and safety of rapamycin combined with CD133 antibody stent in preventing vascular restenosis Yang Feng, Zhao Qian, Zhang Shixuan, Zhao Tienan, Feng Bo 2022, 26 (4):  579-584.  doi: 10.12307/2022.095 Abstract ( 496 )   PDF (1482KB) ( 224 )   Save BACKGROUND: Drug eluting stents and endothelium stents for clinical treatment of vascular stenosis can lead to delayed endothelialization and restenosis. The authors’ previous in vitro studies have shown a rapamycin eluting stent combined with CD133 antibody can play a synergistic role to offset delayed endothelialization and intimal hyperplasia due to antiproliferative drugs. OBJECTIVE: To observe the efficacy of anti-CD133 antibody applied on a rapamycin eluting stent in the minipig coronary artery injury model. METHODS: Rapamycin-eluting stents, anti-CD133 antibody stents, and anti-CD133 antibody applied on rapamycin-eluting stents were implanted in minipig coronary arteries in the rapamycin group, CD133 antibody group, and rapamycin/CD133 antibody group, respectively. Animal experiments were approved by the Laboratory Animal Ethics Committee of Central Hospital Affiliated to Shenyang Medical College (approval No. 20190017) on March 15, 2019.   RESULTS AND CONCLUSION: (1) There were differences in the endothelialization extent in the three groups at 14 days and 1 month after implantation. The stent endothelial coverage of the rapamycin group was lower than that of the CD133 antibody group and the rapamycin/CD133 antibody group. (2) At 3 and 6 months after implantation, the luminal stenosis rate of the rapamycin group and the rapamycin/CD133 antibody group was lower, but there was obvious inflammation in the surrounding tissues of the rapamycin stent, and the CD133 antibody stent could cause obvious intimal hyperplasia and lumen stenosis. (3) It is suggested that rapamycin combined with CD133 antibody stent can achieve early endothelialization in vivo, promote endothelial cell repair, and reduce the inflammation of surrounding tissues after implantation, and its anti-proliferative effect is similar to that of rapamycin stent within 6 months.  Figures and Tables | References | Related Articles | Metrics

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Design and biomechanical properties of dental implant pore structure based on three-dimensional finite element analysis Zhang Jianguo, Chen Chen, Hu Fengling, Huang Daoyu, Song Liang 2022, 26 (4):  585-590.  doi: 10.12307/2022.096 Abstract ( 569 )   PDF (1091KB) ( 249 )   Save BACKGROUND: Studies have shown that the elastic modulus can be changed by changing the pore internal unit structure when designing porous implants, providing a new way to better balance implant strength and elastic modulus. OBJECTIVE: To analyze dental implant biomechanical properties with different micro pore structures by finite element analysis so as to elucidate the effects of different micro pore structures on the surrounding bone stress and implant physical properties. METHODS: A mandibular model and three finite element models of dental implants with different pore structures (conventional structural pores, composite structural pores, and G7 structural pores) were built by CT scanning with porosity of 40%, the thickness of the porous layer of 1.2 mm, and the pore size of 0.45 mm. The ultimate force state was simulated to apply load to each model, which was operated by ANSYS finite element software and analyzed by surrounding bone stress and strain of the implants. RESULTS AND CONCLUSION: (1) When implants were subjected to the ultimate force, the maximum values of effector forces such as 38.324, 56.574, 64.694 MPa for conventional structure, composite structure and G7 structure dental implants on the surrounding cortical bone were respectively 1.836, 10.221, 9.439 MPa, and the maximum values of effector forces such as implants were 156.38, 476.23, 457.76 MPa. The maximum surrounding bone stress of the composite structure implant was within the range of promoting osseointegration. (2) When only lateral forces were applied to the implants, the maximum strain values of dental implants placed in the conventional structure, composite structure and G7 structure were 2.222 9×10-2, 1.661 9×10-2, 3.210 9×10-2 mm/mm. When only axial forces were applied to the implants, the maximum strain values of dental implants placed in the conventional structure, composite structure and G7 structure were 2.266 2×10-3, 1.844 6×10-3, 2.971 5×10-3 mm/mm, indicating that when subjected to lateral static load and axial load, the strain of the composite structure implant was smallest and the micro-movement was small, which helped to improve the osseointegration effect. (3) The results showed that the surrounding bone stress changed significantly with the change of pore unit cell structure inside the porous implant, and the mechanical properties of the implant also changed, and the change of unit cell structure shape of the porous structure on the implant surface significantly affected the elastic modulus and the mechanical properties of the implant. Dental implants with a composite pore structure had better biomechanical properties compared with conventional constructs and G7 constructs. Figures and Tables | References | Related Articles | Metrics

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Preparation and application of acellular scaffold in tissue engineering and regenerative medicine Chen Xiaoxu, Luo Yaxin, Bi Haoran, Yang Kun 2022, 26 (4):  591-596.  doi: 10.12307/2022.097 Abstract ( 733 )   PDF (633KB) ( 1157 )   Save BACKGROUND: Biological scaffolds made from tissue or organ decellularization have been successfully applied to various tissue engineering and regenerative medicine.  OBJECTIVE: To review the preparation methods of acellular scaffolds and their functions and applications in tissue engineering and regenerative medicine. METHODS: Databases of PubMed and CNKI were retrieved with the key words of “decellularization, scaffold, extracellular matrix, tissue regeneration and repair” in English and Chinese. Subjects and abstracts were initially screened to exclude documents that were not related to the subject of the article, and finally 66 articles were included for result analysis. RESULTS AND CONCLUSION: The decellularized scaffolds obtained by decellularizing tissues and organs through physical, chemical and biological methods can effectively retain the components of the extracellular matrix, are non-immunogenic, have good biocompatibility and mechanical properties, and can promote cell adhesion, proliferation, migration and differentiation, induce tissue repair, and reconstruct vascularized and functional tissues and organs. Acellular scaffolds have achieved ideal results in vitro and short-term in vivo experiments of many tissues and organs, such as heart, liver, kidney, lung, trachea, skin and bone, indicating that acellular scaffolds play an important role in tissue regeneration and repair, and have good application prospects. However, to be put into clinical use, more in-depth research and exploration are needed.   Figures and Tables | References | Related Articles | Metrics

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Research hotspot of biological scaffold materials promoting osteogenic differentiation of bone marrow mesenchymal stem cells Kang Kunlong, Wang Xintao 2022, 26 (4):  597-603.  doi: 10.12307/2022.098 Abstract ( 712 )   PDF (644KB) ( 322 )   Save BACKGROUND: At present, a single biological scaffold material is difficult to meet the osteogenic needs of bone tissue engineering, and bone marrow mesenchymal stem cells have excellent osteogenic characteristics. Composite scaffolds and scaffolds combined with growth factors have better osteogenic ability. It is a research hotspot at present. OBJECTIVE: To review different biological scaffolds and their modified scaffolds to promote the osteogenic differentiation of bone marrow mesenchymal stem cells. METHODS: The related articles published in CNKI, Wanfang, VIP, PubMed and Embase databases from January 2014 to July 2020 were searched by the first author with the keywords of “bone marrow mesenchymal stem cells, scaffolds, osteogenic differentiation, hydroxyapatite, collagen, chitosan” in English and Chinese. Finally, 69 articles were selected.  RESULTS AND CONCLUSION: The rapid development of bone tissue engineering can effectively solve the problem of bone defect repair. Seed cells and biological scaffold materials are the core of bone tissue engineering. Bone marrow mesenchymal stem cells have excellent osteogenic differentiation ability and are widely used in bone tissue engineering. The combination of different scaffold materials, the use of advanced preparation technology, or the surface modification of scaffolds and the addition of growth factors can fully combine the advantages of various biological scaffold materials, induce the osteogenic differentiation of bone marrow mesenchymal stem cells and the formation of scaffold blood vessels, and achieve the purpose of repairing bone defects, and is the research focus of bone tissue engineering. Figures and Tables | References | Related Articles | Metrics

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Application of graphene-based nanomaterials in stem cells Shen Jiahua, Fu Yong 2022, 26 (4):  604-609.  doi: 10.12307/2022.099 Abstract ( 702 )   PDF (628KB) ( 154 )   Save BACKGROUND: As a kind of newly-developing nanomaterial, graphene has been used in many fields. Many recent studies have found that graphene-based nanomaterials can affect the biological behaviors of stem cells. OBJECTIVE: To review the application and progress of graphene-based nanomaterials in stem cells. METHODS: We searched the articles about the application of graphene-based nanomaterials in stem cells published in PubMed, Web of Science, and CNKI databases with the search terms “graphene, nanomaterials, stem cell” in English and Chinese. Finally, 57 articles met the criteria for review.  RESULTS AND CONCLUSION: Graphene-based nanomaterials have good stability and corrosion resistance, high mechanical strength, good biocompatibility, which are accepted as one of the most promising nanomaterials in biomedicine. Stem cells are undifferentiated cells that can differentiate into various mature cells in human body, which have a broad application prospect in tissue engineering, regenerative medicine and other fields. Many recent studies have applied graphene-based nanomaterials to stem cell research and found that they can affect the growth, proliferation, adhesion and differentiation of stem cells, and these nanomaterials may affect the biological behavior of stem cells by regulating the expression of related genes and various signaling pathways. However, graphene-based nanomaterials have biological toxicity, which restrict their application in biological aspects. Moreover, most researches only involved cellular level, and it needs further animal studies and in vivo experimental researches. Figures and Tables | References | Related Articles | Metrics

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Application and value of polymer materials in three-dimensional printing biological bones and scaffolds Wang Ruanbin, Cheng Liqian, Chen Kai 2022, 26 (4):  610-616.  doi: 10.12307/2022.100 Abstract ( 951 )   PDF (734KB) ( 908 )   Save BACKGROUND: At present, the main factors restricting the development of three-dimensional (3D) technology are the limited types of printable materials, and polymer materials have made great progress in the field of 3D printing biological bones and scaffolds due to their excellent physical and chemical properties and variety. OBJECTIVE: To review application status of polymer materials in the biological field and the advantages and disadvantages of 3D printing technology. METHODS: CNKI, Wanfang, VIP, and PubMed databases were searched for articles published from 2000 to 2020. The Chinese key words were “3D printing, fused deposition molding, UV curing molding technology, selective laser sintering technology, natural polymer, synthetic polymer, biomedical, artificial bone, artificial bone scaffold”. The English key words were “3D printing; FDM; SLA; SLS; natural polymer; synthetic polymer; biomedical; artificial bone; artificial bone scaffold”. Finally, 56 articles were selected to summarize. RESULTS AND CONCLUSION: Polymer materials play a more and more important role in the biological field because of their wide variety, excellent physical and chemical properties, high dimensional accuracy, good processability and other characteristics. Not only that, the composite of polymer materials with metal and inorganic can improve their biocompatibility, controllable degradation and other characteristics, which further expands the application space of polymer materials in the biological field. 3D printing technology is mainly through the combination of information technology and manufacturing technology to achieve 3D solid printing, which is with the characteristics of rapid, accurate, personalized customization. 3D printing is widely used in biomedical, casting, aerospace and other fields. The combination of polymer materials and 3D printing technology can realize the personalized customization of human bones, organs and tissues, which is expected to solve the problem of insufficient donors in clinic. Therefore, the research and development of biomedical materials more suitable for 3D printing process and how to better combine polymer materials with 3D printing technology become the current research hotspot. Figures and Tables | References | Related Articles | Metrics

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Hyaluronic acid-based composite hydrogel in cartilage injury caused by osteoarthritis: application and mechanism Zhang Tong, Cai Jinchi, Yuan Zhifa, Zhao Haiyan, Han Xingwen, Wang Wenji 2022, 26 (4):  617-625.  doi: 10.12307/2022.101 Abstract ( 1115 )   PDF (790KB) ( 4321 )   Save BACKGROUND: Hyaluronic acid is a natural polysaccharide and a common glycosaminoglycan in human body. It has the highest concentration in eyes and joints. It is made into hydrogels because of its biocompatibility, degradability, and low immunogenicity, and is widely used in tissue engineering. OBJECTIVE: To introduce the characteristics of various hyaluronic acid composite hydrogels and their application in the repair of cartilage damage caused by osteoarthritis. METHODS: CNKI and Wanfang databases were searched with the key words of “hyaluronic acid, hydrogel, cartilage repair, osteoarthritis” in Chinese. PubMed and Web of Science databases were searched with the key words of “hyaluronic acid, hydrogel, cartilage repair, osteoarthritis” in English. The articles published from January 1995 to July 2020 were searched and further analyzed and summarized.  RESULTS AND CONCLUSION: The excellent biological properties of hyaluronic acid hydrogel have made it widely studied in the cartilage repair of osteoarthritis, especially through the combination of biological factors, natural materials, synthetic materials, 3D printing technology, polypeptides, mechanical stimulation, etc., which improved the performance of hyaluronic acid hydrogel and promoted its application in cartilage tissue engineering. Although hyaluronic acid composite hydrogels have been studied more, with the comprehensive development of chemistry, materials, physics, biology and other disciplines in the future, a deeper understanding of the degradation mechanism of hyaluronic acid hydrogels and an exploration of the cartilage damage mechanism in osteoarthritis, the hyaluronic acid composite hydrogel is expected to be designed with high efficiency, no side effects and more suitable for cartilage tissue engineering. Figures and Tables | References | Related Articles | Metrics

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Application and characteristics of bone graft materials in the treatment of spinal tuberculosis Li Hui, Chen Lianglong 2022, 26 (4):  626-630.  doi: 10.12307/2022.102 Abstract ( 781 )   PDF (712KB) ( 178 )   Save BACKGROUND: Thorough removal of local necrotic lesions and one-stage use of bone repair materials can significantly promote local bony fusion, avoid recurrence of tuberculosis in the middle and long terms and reconstruct spinal stability in the surgical treatment of spinal tuberculosis.   OBJECTIVE: To review the application of bone graft materials in the treatment of spinal tuberculosis. METHODS: The first author searched the articles related to bone graft materials of spinal tuberculosis in Bailian, CNKI, and Natures databases published from 2001 to 2020. The priority was the articles published recently or in authoritative journals. The search keywords were “bone graft materials, bone tissue engineering; spinal tuberculosis; titanium mesh; autogenous bone” in Chinese and English. RESULTS AND CONCLUSION: At present, bone graft materials have been widely used in clinic, but each has its own disadvantages. For example, the amount of autologous bone is limited, and the transplantation of autologous bone will cause bleeding and potential complications of donor site; allogeneic bone will lead to delayed healing and infection; titanium mesh has the problems of postoperative subsidence and kyphosis correction angle loss; the organic polymer materials such as polylactic acid and polymethyl methacrylate are lack of bone induction performance. Although Ca/P-based ceramic materials can be used as carrier materials of antituberculosis drugs, their biomechanical properties cannot fully meet the clinical needs. In view of the shortcomings of the above materials, it is necessary to find a composite bone tissue engineering material, which can meet the requirements of good biocompatibility, mechanical properties, degradation properties, osteogenic activity, and drug release performance. Figures and Tables | References | Related Articles | Metrics

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Percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: navigation, fracture reduction system, bone cement leakage, and material modification Wang Zhiqiang, Lin Lu, Chen Xiaolin, Ke Zhenyong 2022, 26 (4):  631-636.  doi: 10.12307/2022.103 Abstract ( 469 )   PDF (658KB) ( 540 )   Save BACKGROUND: Percutaneous vertebroplasty is an important treatment for osteoporotic vertebral compression fractures. With the development of clinical practice, its limitations gradually revealed. Many researchers have studied and improved it. OBJECTIVE: To summarize the latest research progress on the navigation and surgical approach, fracture reduction system, prevention of cement leakage, and bone cement materials.  METHODS: The computer was used to search relevant articles from PubMed, Embase, CNKI, Wanfang, and VIP databases from January 2000 to April 2020. The Chinese and English terms were “osteoporotic vertebral compression fracture, percutaneous vertebral augmentation, percutaneous vertebroplasty, percutaneous kyphoplasty”. After consulting the relevant articles, 61 articles were included to analyze the results. RESULTS AND CONCLUSION: (1) O-arm navigation and 3D printing technology are very helpful for patients with upper thoracic vertebral compression fracture, severe vertebral compression fracture, and compression fracture with scoliosis. (2) Most opinions think that unilateral approach is more advantageous than bilateral approach, but further research is still necessary. (3) There are many fracture reduction systems and technologies of preventing cement leakage. Different structural characteristics make them have their own advantages, which one should be chosen to treat patients depends on different conditions. (4) Calcium phosphate cement has great potential and may gradually replace traditional bone cement materials in the future. Figures and Tables | References | Related Articles | Metrics

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Electrospinning for rotator cuff repair Gao Cangjian, Yang Zhen, Liu Shuyun, Li Hao, Fu Liwei, Zhao Tianyuan, Chen Wei, Liao Zhiyao, Li Pinxue, Sui Xiang, Guo Quanyi 2022, 26 (4):  637-642.  doi: 10.12307/2022.104 Abstract ( 581 )   PDF (834KB) ( 483 )   Save BACKGROUND: The structure of nanofibers prepared by electrospinning technology is similar to that of natural tendon tissue and extracellular matrix, and has the inherent characteristics of nanofibers.  OBJECTIVE: To review the structure of various electrospinning scaffolds and their application in tendon and rotator cuff tissue engineering systematically. METHODS: PubMed, CNKI, Wanfang, and Web of Science databases were searched for relevant articles published from 2000 to 2020 with the search terms of “electrospun, tendon, rotator cuff, tissue engineering” in both English and Chinese. Totally 69 articles were finally included for analysis. RESULTS AND CONCLUSION: There are various strategies in manufacturing electrospun scaffolds. Scaffolds differ from material selection, fiber composition, modification and drug loading and many other aspects. Natural and synthetic materials both have their own advantages. Hybrid electrospinning of more than two kinds of materials can produce unique properties. Although non-aligned fibers have better tensile length, aligned fibers have advantages in elastic modulus, fracture strength and biocompatibility. Nanofibrous scaffolds can also be used in drug release, and it may have a modified characteristic and improve rotator cuff and tendon healing. Figures and Tables | References | Related Articles | Metrics

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Platelet-rich fibrin as a material for alveolar ridge preservation significantly reduces the resorption of alveolar bone height and width after tooth extraction: a meta-analysis Wei Zhoudan, Li Wenjin, Zhu Li, Wang Yu, Zhao Jiaoyang, Chen Yanan, Guo Dong, Hao Min 2022, 26 (4):  643-648.  doi: 10.12307/2022.105 Abstract ( 560 )   PDF (806KB) ( 405 )   Save OBJECTIVE: At present, platelet-rich fibrin is widely used in site retention after tooth extraction, but the effect of platelet-rich fibrin in alveolar ridge preservation is not very clear compared with other materials. This study evaluated the effect of applied platelet-rich fibrin in the preservation of alveolar ridge after tooth extraction to provide theoretical basis for clinical application of platelet-rich fibrin to reduce alveolar bone resorption.  METHODS: Up to June 2020, all clinical randomized controlled studies on platelet-rich fibrin for alveolar ridge preservation, including platelet-rich fibrin alone and platelet-rich fibrin combined with heterogeneous bone, were collected by using The Cochrane Library, PubMed, Web of science core set, EMbase, CNKI, and Wanfang databases. Two researchers extracted data from the retrieved documents and used Cochrane bias risk assessment tools to evaluate the bias risk included in the study. RevMan 5.3 software was used for meta-analysis. RESULTS: (1) Totally 159 articles were retrieved, and 11 randomized controlled trials were finally included, involving 531 patients and 575 implants. (2) The results of meta-analysis showed that the difference in the height absorption of tooth alveolar bone was not statistically significant when platelet-rich fibrin was applied alone (SMD=-0.38, 95%CI:-0.83 to -0.06, P > 0.05). There were significant differences between platelet-rich fibrin composite heterogeneous bone and simple xenogeneic bone in alveolar bone resorption height (3 months: SMD=-1.40, 95%CI:-1.79 to -1.01, P < 0.05; 6 months: SMD=-1.37, 95%CI:-1.68 to -1.06, P < 0.05), alveolar bone resorption width at 3 and 6 months after tooth extraction (SMD=-0.18, 95%CI:-0.25 to -0.11, P < 0.05), and mouth mucosa healing rate at 2 weeks after tooth extraction (SMD=9.90, 95%CI:8.61-11.19, P < 0.05).  CONCLUSION: Applying platelet-rich fibrin composite heterogeneous bone after tooth extraction can remarkably reduce the resorption of alveolar bone both in height and width and accelerate soft tissue healing. Because of the small sample size included in the study, clinical studies with a large sample size are needed to verify the above conclusions. Figures and Tables | References | Related Articles | Metrics

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Comparative clinical efficacy of polymethyl methacrylate and self-solidifying calcium phosphate cement in vertebroplasty: a meta-analysis  Ou Liang, Kong Dezhong, Xu Daoqing, Ni Jing, Fu Xingqian, Huang Weichen 2022, 26 (4):  649-656.  doi: 10.12307/2022.106 Abstract ( 572 )   PDF (1302KB) ( 114 )   Save OBJECTIVE: Vertebroplasty is widely used in the treatment of osteoporotic vertebral fractures. At present, polymethyl methacrylate is still the most commonly used filling material for strengthening vertebral body, but it is not the most ideal filling material. Self-curing calcium phosphate cement is a new filling material developed in recent years, which can naturally heal with bone tissue and be absorbed and replaced by the human body. This meta-analysis systematically analyzed the clinical efficacy and safety of polymethyl methacrylate and self-solidifying calcium phosphate cement in vertebroplasty.   METHODS: China National Knowledge Infrastructure, Wanfang database, Chinese Biomedical Medicine database, PubMed, EMbase, and Cochrane Library database were retrieved for clinical control studies regarding with polymethyl methacrylate and self-solidifying calcium phosphate cement treatment of osteoporotic vertebral compression fracture. The retrieval period was from the database inception to July 2020. The visual analogue scale score, vertebral kyphosis Cobb angle, vertebral body height, bone cement leakage rate, adjacent vertebral fracture rate, Oswestry dysfunction index, and clinical curative effect were used as the outcome indexes. All the literature screening, data extraction and research quality evaluation were carried out independently by two reviewers. In addition, the Cochrane Collaboration tool and the Newcastle-Ottawa scale were used to evaluate the quality of randomized controlled trials and cohort studies, respectively. RevMan 5.4 software was used for meta-analysis. RESULTS: (1) A total of nine studies involving 593 patients were included in the meta-analysis; five of which were randomized controlled trials, and four were retrospective cohort studies. All of the selected studies were of high quality. (2) Meta-analysis results showed that there was no significant difference between the two filling materials in the following aspects, including visual analogue scale score (SMD=-0.45, 95%CI:-1.10-0.21, P=0.18), Cobb angle of vertebral kyphosis (MD=-0.16, 95%CI:-0.43-0.11, P=0.24), height of vertebral body (SMD=0.13, 95%CI:-0.12-0.37, P=0.32), leakage rate of bone cement (OR=1.30, 95%CI:0.67-2.54, P=0.44), Oswestry disability index (MD=3.31, 95%CI:-1.34-7.97, P=0.16), and clinical effective rate (OR=1.00, 95%CI:0.14-7.27, P=1.00). However, in terms of new fractures of adjacent vertebrae, the calcium phosphate cement group was significantly better than the polymethyl methacrylate group (OR=2.17, 95%CI:1.04-4.51, P=0.04). CONCLUSION: The application of calcium phosphate cement in vertebroplasty has a significant advantage in reducing adjacent vertebral fractures compared with polymethyl methacrylate. The curative effect is similar in pain visual analogue scale score, vertebral kyphosis Cobb angle, vertebral body height, bone cement leakage rate, and Oswestry dysfunction index. However, more high-quality randomized controlled trials are needed to provide more sufficient evidence. Figures and Tables | References | Related Articles | Metrics