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28 January 2023, Volume 27 Issue 3 Previous Issue    Next Issue

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Inorganic ion bionic periosteum regulates immune microenvironment to promote bone repair Zhang Lichen, Chen Liang, Gu Yong 2023, 27 (3):  346-353.  doi: 10.12307/2023.010 Abstract ( 562 )   PDF (1601KB) ( 134 )   Save BACKGROUND: The biomimetic periosteum synthesized by mesoporous bioactive glass nanoparticles and methacrylic acid gelatin can release calcium, silicon and phosphorus ions in the local area of bone defect and promote osteogenesis. However, silicon ions can also regulate the polarization of macrophages, so the effect of bionic periosteum on local inflammatory microenvironment of bone defect still needs to be explored.  OBJECTIVE: To explore the relationship between the regulation of inflammatory microenvironment and the promotion of bone repair by inorganic ion biomimetic periosteum in vivo and in vitro.  METHODS: (1) In vitro: The bionic periosteum was obtained by photocrosslinking mesoporous bioactive glass nanoparticles and methacrylic acid gelatin. Inductively coupled plasma spectroscopy was used to observe the release of Si4+ from biomimetic periosteum within 7 days. Bone marrow mesenchymal stem cells were inoculated into methacrylic acid gelatin hydrogel and mesoporous bioactive glass nanoparticles/methacrylic acid gelatin composite hydrogel separately. With the simple cultured cells as control, the biocompatibility of the cells was detected by Live/Dead fluorescence staining. Bone macrophages were inoculated in methacrylic acid gelatin hydrogel and mesoporous bioactive glass nanoparticles/methacrylic acid gelatin composite hydrogel separately. With simple cultured cells as control, the effect of bionic periosteum on macrophage phenotype in vitro was detected by nitric oxide synthase (macrophage M1 phenotype) and CD206 (macrophage M2 phenotype) immunofluorescence staining. (2) In vivo: The rat model of skull defect was established, and methacrylic acid gelatin hydrogel and mesoporous bioactive glass nanoparticles/methacrylic acid gelatin hydrogel were implanted into the bone defect. The local macrophage phenotype of bone defect was detected by RT-PCR at 7 days after operation, and the osteogenic property of biomimetic periosteum was detected by hematoxylin-eosin staining at 8 weeks after operation.  RESULTS AND CONCLUSION: (1) In vitro: The bionic periosteum released Si4+ to the maximum concentration within 24 hours, and released slowly within 6 days after that. After co-culture for 3 days, Live/Dead fluorescence staining showed that the bone marrow mesenchymal stem cells in each group grew well, had good cell activity, and had no obvious death. After co-culture for 7 days, the results of immunofluorescence staining showed that most of the macrophages in the bionic periosteum group were M2, while those in the methacrylic acid gelatin group and control group were M1. After co-culture for 7 days, the results of alkaline phosphatase staining showed that the staining in the bionic periosteum group was stronger than that in the control group and the methacrylic acid gelatin group. (2) In vivo: RT-PCR results showed that most of the macrophages in the local inflammatory microenvironment of the bone defect of the rats implanted with bionic periosteum were M2, while most of the macrophages in the blank group and the methacrylic acid gelatin group were M1. Hematoxylin-eosin staining showed that there were more new bones in the bionic periosteal group than in the blank group and the methacrylic acid gelatin group. (3) The results showed that the inorganic ion bionic periosteum promoted the M2 polarization of macrophages in the inflammatory region through the release of Si4+, which could inhibit inflammation and promote osteogenesis.  Figures and Tables | References | Related Articles | Metrics

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Barium titanate/polylactic acid piezoelectric composite film affects adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 cells Dai Xianglin, Zhang Wenfeng, Yao Xijun, Shang Jiaqi, Huang Qiujin, Ren Yifan, Deng Jiupeng 2023, 27 (3):  367-373.  doi: 10.12307/2023.002 Abstract ( 731 )   PDF (1961KB) ( 168 )   Save BACKGROUND: Electrical stimulation has been shown to promote bone regeneration and piezoelectric materials with bioelectrical activity can be used in bone tissue engineering. OBJECTIVE: To prepare an ideal piezoelectric film material, which can promote bone regeneration and characterize its effects on the adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 cells.  METHODS: Barium titanate/polylactic acid composite film was prepared by solution casting with polylactic acid as raw material and a certain proportion (0%, 5%, 10%, 20%, 30%, and 40%) of piezoelectric ceramic barium titanate was added and methylene chloride was selected as the organic solvent. After corona polarization treatment, the surface morphology, crystal phase composition, hydrophilic and piezoelectric properties of films were investigated to select materials with better physical and chemical properties. The 0% and 20% barium titanate/polylactic acid composite film materials before and after polarization treatment were separately co-cultured with MC3T3-E1 cells to test the ability of cell adhesion, proliferation, and osteogenic differentiation.  RESULTS AND CONCLUSION: (1) The scanning electron microscope, X-ray diffraction, water contact angle experiment, and pressure point constant test results showed that when the mass ratio of barium titanate to composite film was 20%, the polarized composite film material had good physical and chemical properties. The piezoelectric constant d33 after polarization reached (7.03±0.26) pC/N, which was in the normal piezoelectric range of bone tissue. (2) CCK-8 assay results showed that on the 4th day of culture, the proliferation activity of the cells in the polarized 20% group was higher than that in the unpolarized 20% group (P < 0.05). On the 7th day of culture, the proliferation activity of the cells in the polarized 20% group was higher than that of the blank control group, the unpolarized 0% group, and the unpolarized 20% group (P < 0.05). (3) The fluorescence microscope and scanning electron microscope exhibited that the cells in the polarized 20% group were polygonal and had obvious pseudopodia. Compared with the unpolarized 20% group, polarized 0% group and unpolarized 0% group showed better cell adhesion ability. (4) The alkaline phosphatase activity detection results showed that on the 4th day of culture, the alkaline phosphatase activity of the polarized 20% group was higher than that in the unpolarized 0% group and the unpolarized 20% group (P < 0.05). On the 7th day of culture, the alkaline phosphatase activity of the polarized 20% group was higher than that of the unpolarized 0% group, the unpolarized 20% group, and polarized 0% group (P < 0.05). (5) The barium titanate/polylactic acid composite piezoelectric film material has good piezoelectric properties and cytocompatibility. Figures and Tables | References | Related Articles | Metrics

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3D printed polyetheretherketone material for skull defect repair Zhai Hongjie, Han Guanda, Li Lei, Dong Xiaohui, Jiang Zhiquan, Lou Feiyun 2023, 27 (3):  380-384.  doi: 10.12307/2023.003 Abstract ( 659 )   PDF (1113KB) ( 100 )   Save BACKGROUND: During cranioplasty, the postoperative effects of different cranial repair materials are different, and the occurrence of postoperative complications is also quite different. OBJECTIVE: To study the clinical effect of 3D printed polyetheretherketone material in cranioplasty. METHODS: 112 patients with skull defect admitted to The First Affiliated Hospital of Bengbu Medical College from February 2016 to August 2020, including 67 males and 45 females, were selected and subjected to cranioplasty. The patients were divided into polyetheretherketone group (n=36) and titanium mesh group (n=76). Postoperative  follow up was conducted to observe the occurrence of complications in the two groups, including subcutaneous effusion, hydrocephalus, epidural or subdural hematoma, poor wound healing, implant leakage, or infection.  RESULTS AND CONCLUSION: (1) The patients in the polyetheretherketone group and titanium mesh group were followed up for (14.64±2.39) and (15.49±2.17) months after surgery, respectively, and there was no significant difference between the groups (P > 0.05). There were no patients with implant failure due to implant material in either group. (2) Complications occurred in 33 patients in the titanium mesh group, including 1 case of hydrocephalus, 9 cases of subcutaneous fluid, 3 cases of epidural/subhematoma, 13 cases of poor wound healing, and 3 cases of implant exposure, and 4 cases of intracranial infection. The complication rate was 43.4%. Totally 10 patients in the polyetheretherketone group had complications, including 6 cases of subcutaneous effusion, 1 case of epidural/subhematoma, and 2 cases of poor wound healing, and 1 case of intracranial infection; the complication rate was 27.8%. There was no significant difference in the total postoperative complication rate between the two groups (P > 0.05), but the incidence of poor wound healing/implant exposure was significantly different (P < 0.05). (3) It is concluded that 3D printed polyetheretherketone repair material has good biocompatibility, safety and accuracy in the application of skull defect repair. Compared with titanium mesh repair material, polyetheretherketone has a better advantage in wound healing.   Figures and Tables | References | Related Articles | Metrics

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Biomechanical comparison between a novel bone cement screw system and common surgical methods for the treatment of Kummell’s disease Zhan Yi, Wang Biao, Ma Yuli, He Simin, Sun Honghui, Hao Dingjun 2023, 27 (3):  385-390.  doi: 10.12307/2023.001 Abstract ( 447 )   PDF (1342KB) ( 39 )   Save BACKGROUND: Kyphoplasty and vertebroplasty, as the main treatment of Kummell’s disease, are prone to bone cement displacement during or after surgery. Concerning this complication, the authors’ team designed a novel bone cement screw system. OBJECTIVE: To explore the application value of the novel bone cement screw system in Kummell’s disease. METHODS: Thoracolumbar vertebrae specimens of 15 fresh female adult cadavers aged over 60 years were used, and no fractures or deformities were found in the specimens, and all were associated with osteoporosis. The T12-L2 segments were taken, and the Kummell’s disease models were made at the L1 segment, and then five type bone cement repair models were established: group A: vertebroplasty; group B: vertebroplasty combined with unilateral pediculoplasty; group C: vertebroplasty combined with bilateral pediculoplasty model; group D: unilateral novel bone cement screw combined with vertebroplasty model; group E: bilateral novel bone cement screw combined with vertebroplasty model; each group of models contained three specimens. The three-dimensional motions in the six directions of anterior flexion and posterior extension, left and right lateral bending, and left and right rotation were performed by the six-axis spine robot. RESULTS AND CONCLUSION: (1) The five models were well filled with bone cement, and there was no bone cement leakage or bone cement displacement. (2) Under the anterior flexion, posterior extension, left and right lateral bending, the bone cement stability of the groups D and E was better than that of the other three models (P < 0.05). The novel bone cement screw system in the anterior flexion state had the best biomechanical stability, followed by the extension state. Under the left and right rotation, there were no statistical differences the between the five groups of models (P > 0.05). There was almost no significant difference in bone cement stability in the six directions of motion in groups D and E (P > 0.05). (3) For Kummell’s disease, the novel bone cement screw system has better biomechanical stability than the current commonly used treatments, and both unilateral and bilateral novel bone cement screw systems have good results.  Figures and Tables | References | Related Articles | Metrics

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Finite element analysis and application of unilateral and bilateral bone-filling mesh container in treatment of osteoporotic vertebral compression fracture Lu Hui, Wu Qimei, Liu Rong 2023, 27 (3):  391-397.  doi: 10.12307/2023.016 Abstract ( 507 )   PDF (1491KB) ( 115 )   Save BACKGROUND: In the treatment of osteoporotic vertebral compression fracture, bone-filling mesh container has a significant curative effect. Considering the operation time, lateral leakage of bone cement and the number of radiation exposure, unilateral approach is better. However, no study compared unilateral bone-filling mesh container and bilateral bone-filling mesh container from the perspective of biomechanics, lacking certain theoretical data support. OBJECTIVE: To investigate the biomechanical characteristics and clinical effects of unilateral and bilateral bone-filling mesh container approaches in the treatment of osteoporotic vertebral compression fracture. METHODS: (1) A finite element model was established to simulate the treatment of osteoporotic vertebral compression fracture with unilateral and bilateral bone-filling mesh container. The displacement and stress changes of the whole finite element model of thoracolumbar segment in the unilateral bone-filling mesh container group and bilateral bone-filling mesh container group were compared and analyzed under 400 N vertical downward loading force and 7.5 N·m bending moment load under four working conditions. (2) A retrospective analysis was performed on 99 patients with osteoporotic vertebral compression fracture who were treated with bone-filling mesh container from January 2018 to August 2020 in Wuhan Puren Hospital. Of them, 49 patients were treated with unilateral bone-filling mesh container and 50 patients were treated with bilateral bone-filling mesh container. Bone cement leakage rate, visual analogue scale score, and Cobb angle change were analyzed between the two groups.  RESULTS AND CONCLUSION: (1) Finite element model: There was no significant difference in the maximum displacement between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). There was no significant difference in the maximum stress between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). (2) Clinical trial: The bone cement leakage rates in the unilateral and bilateral approach groups were 12% and 16%, respectively, and the visual analogue scale score and scoliosis angle at 6 months after surgery were significantly improved compared with those before operation in both groups (P < 0.001). There was no significant difference in visual analogue scale score and scoliosis angle between the two groups at 6 months after operation (P > 0.05). (3) From the perspective of biomechanics and clinical efficacy, unilateral bone-filling mesh container approach is more effective than bilateral bone-filling mesh container approach in treating osteoporotic vertebral compression fracture.  Figures and Tables | References | Related Articles | Metrics

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Effects of hyaluronic acid combined with domestic porous tantalum on chondrocyte function under the dynamic environment Zhang Hui, Wang Jiayang, Wang Qian, Gan Hongquan, Wang Zhiqiang 2023, 27 (3):  339-345.  doi: 10.12307/2023.025 Abstract ( 515 )   PDF (1669KB) ( 34 )   Save BACKGROUND: The effect of composite culture of scaffold materials and biological factors on chondrocyte function in different conditions is a hot topic in the research of tissue-engineered materials. OBJECTIVE: To investigate the effect of hyaluronic acid combined with domestic porous tantalum on the function of rat chondrocytes under the dynamic environment.  METHODS: Knee chondrocytes of SD rats were extracted and cultured. Five groups of experiments were established as static culture group (group A), tantalum static group (group B), tantalum hyaluronic acid static group (group C), tantalum dynamic group (in the dynamic bottle rotation, two-way alternating forward and reverse rotation; the rotation angle is 40°, 40 r/h; group D), and tantalum hyaluronic acid dynamic group (in the dynamic bottle rotation, two-way alternating forward and reverse rotation; the rotation angle is 40°, 40 r/h; group E). The samples were continuously cultured for 7 days in the five groups. Cell morphology on materials was observed under a scanning electron microscope. The secretion of proteoglycan, type II collagen and SOX9 was detected by ELISA. The expression levels of proteoglycan, type II collagen and SOX9 protein were detected by western blot assay.  RESULTS AND CONCLUSION: (1) Scanning electron microscope observation showed that with the prolongation of static culture time, the number of chondrocytes in group C gradually increased, and gradually covered the surface of tantalum material. (2) On the 5th day of culture, the secretion of proteoglycan and type II collagen in group C was higher than that in groups A and B (P < 0.05). The secretion of SOX9 in group D was lower than that in group E (P < 0.05). The secretion of proteoglycan and type II collagen in group B was lower than that in group D (P < 0.05). The secretion of proteoglycan and type II collagen in group C was lower than that in group E (P < 0.05). (3) On the 5th day of culture, the expression of type II collagen in group C was higher than that in group B (P < 0.05), and the expression of proteoglycan and type II collagen in group D was higher than that in group B (P < 0.05). The expression levels of proteoglycan and type II collagen in group E were higher than those in group C (P < 0.05). (4) These findings suggest that the combination of domestic porous tantalum and hyaluronic acid can promote the secretion and protein expression of proteoglycan and type II collagen in chondrocytes. Under dynamic environment culture, the secretion and protein expression of proteoglycan and type II collagen are better than in static culture. SOX9 secretion and protein expression are not affected by the dynamic and static culture environments.   Figures and Tables | References | Related Articles | Metrics

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In vitro construction of Stanford type A aortic dissection 3D dynamic simulation diagram and individual tissue-engineered blood vessels Cheng Mingguang, Zhang Chaoyu, Zhuang Kangle, Ruan Peng, Zuo Yi, Zhou Zhengchun, Kong Xiang, Ge Jianjun, Cheng Guangcun 2023, 27 (3):  335-338.  doi: 10.12307/2023.021 Abstract ( 981 )   PDF (933KB) ( 38 )   Save BACKGROUND: Stanford type A aortic dissection operation is difficult and complex, requiring total ascending aortic arch replacement and descending aortic stent implantation under deep hypothermic circulation arrest. The operator has high operational requirements.  OBJECTIVE: To explore the feasibility of constructing Stanford type A aortic dissection 3D dynamic simulation diagram in vitro and preparing individual tissue-engineered blood vessels, so as to provide simulated surgical process for clinicians in the future. METHODS: A total of 17 Stanford type A aortic dissection patients admitted to the First Affiliated Hospital (Anhui Provincial Hospital) of University of Science and Technology of China from January 2020 to July 2021 were selected and their image data were imported into medical image processing software. The simulation of Stanford type A aortic dissection was reconstructed. For the reconstructed aortic vessel model, the 3D dynamic simulation diagram of the dissection was developed, and the individual tissue-engineered vessels were developed. Meanwhile, the average difference between the aortic dissection model and aortic dissection CT angiography at different positions was measured. RESULTS AND CONCLUSION: (1) Accurate formulation of 3D dynamic simulation diagram and model of interlayer could prepare individual tissue-engineered blood vessels to meet the needs of clinical artificial blood vessel materials. (2) In horizontal aorta at sinus canal junction, horizontal aorta of brachiocephalic trunk, horizontal aorta of left subclavian artery, brachiocephalic trunk, left common carotid artery and left subclavian artery, there was no significant difference between the inner diameter value of the 3D dynamic model of Stanford type A aortic dissection and the results of CT angiography (P > 0.05). (3) It is concluded that constructing 3D dynamic simulation diagram of Stanford type A aortic dissection in vitro and accurately printing the complex anatomical structure of Stanford type A aortic dissection can accurately prepare individual tissue-engineered blood vessels.  Figures and Tables | References | Related Articles | Metrics

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Osteogenic capacity of partially demineralized dentin particles in the maxillary sinus lift Liu Huan, Li Han, Ma Yunhao, Zhong Weijian, Ma Guowu 2023, 27 (3):  354-359.  doi: 10.12307/2023.050 Abstract ( 540 )   PDF (1095KB) ( 50 )   Save BACKGROUND: It has been confirmed that dentin particles obtain good osteogenic potential. The non-demineralized dentin particles maintained well in space, but their degradation and absorption were slow, which delayed the rate of new bone formation. The fully demineralized dentine particles degraded rapidly, but the effect of scaffolds was not good, and the amount of new bone formation was limited.  OBJECTIVE: To evaluate the tissue reaction and osteogenic effect of partially demineralized dentin matrixs as bone graft materials. METHODS: The enamel, cementum, and pulp were removed from clinically collected teeth, and the healthy dentin was preserved. The undemineralized dentin particles of 0.5-1.0 mm in diameter were prepared by grinding, screening, boiling, and sterilization. The dentin particles were demineralized in 2% nitric acid for 10 minutes, then cleaned and disinfected to produce partially demineralized dentin particles. Five beagles were selected for bilateral maxillary sinus elevation and randomly divided into two groups. Sinus in the experimental group was filled with partially demineralized dentin particles, and that in the control group was filled with undemineralized dentin particles. Three months after bone grafting, specimens were analyzed by gross observation, X-ray imaging and histological examination. RESULTS AND CONCLUSION: (1) General observation: The bone graft area in the two groups healed well without inflammation. In the experimental group, the surface of the bone graft area was flat, with remaining dentin particles. In the control group, the surface of the bone graft area was uneven, with a large number of remaining dentin particles. (2) Cone beam CT examination: In the experimental group, low-density image was observed; the boundary between dentin particles and surrounding tissues was unclear; the total volume of dentin particles in the bone graft area was decreased; and the density of new bone between dentin particles was increased. In the control group, the high density dentin particle image and surrounding tissue boundary were obvious, and dentin absorption was less compared with the experimental group. (3) Histological analysis: There was no obvious inflammatory cell infiltration in the bone graft area of the two groups. In the experimental group, dentin particles were absorbed like insect erosion, surrounded by new bone tissue; newly-born braided bones were dense. In the control group, the absorption degree of dentin particles was less than that in the experimental group. The rate of new bone formation was lower in the control group than that in the experimental group (P < 0.05). (4) The results show that both partially demineralized and undemineralized dentin particles could induce new bone formation. The osteogenic effect of partially demineralized dentin particles was better than that of undemineralized dentin particles.  Figures and Tables | References | Related Articles | Metrics

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Aspirin-loaded chitosan nanoparticles and polydopamine modified titanium sheets improve osteogenic differentiation Li Rui, Liu Zhen, Guo Zige, Lu Ruijie, Wang Chen 2023, 27 (3):  374-379.  doi: 10.12307/2023.006 Abstract ( 642 )   PDF (1902KB) ( 74 )   Save BACKGROUND: Titanium as a bone substitute material has been widely used in the field of oral implant devices, but its bioinert would affect the stable combination with bone tissue at the early stage of implantation. Therefore, exploring to improve the osteogenic properties of titanium through surface modification is necessary.  OBJECTIVE: To investigate the effect of composite coating of aspirin loaded chitosan nanoparticles and polydopamine on the viability of osteoblasts in vitro.   METHODS: The titanium sheets modified by polydopamine coating as well as aspirin loaded chitosan nanoparticles and polydopamine composite coating were constructed. The surface morphology and microstructure of the coatings were characterized by scanning electron microscopy. In vitro sustained-release properties of aspirin nanosphere coatings on pure titanium were detected. Rat bone marrow mesenchymal stem cells were seeded and cultured on the pure titanium sheet and the two kinds of modified titanium sheets. The spreading morphology of rat bone marrow mesenchymal stem cells on the surface of titanium sheets was observed by cytoskeleton staining. Cell proliferation was determined by CCK-8 assay. The osteogenic differentiation of rat bone marrow mesenchymal stem cells on titanium sheets was measured using alkaline phosphatase staining and immunofluorescence staining.  RESULTS AND CONCLUSION: (1) Scanning electron microscope images showed that the pure titanium surface was relatively smooth, and deposits as well as grain appeared after the dopamine polymerization. Aspirin microspheres were spherical with uniform size distribution. The hydrophilicity of the nanoparticles immobilized titanium surfaces and the polydopamine coating modified titanium surfaces were better than that of the pure titanium sheets (P < 0.05). The aspirin appeared to be slow and sustained under the encapsulation of chitosan nanoparticles. (2) As observed by cytoskeleton staining, the cells showed insufficient cell expansion on the surface of the pure titanium sheets and formed a few filopodia on the dopamine modified titanium sheets. The cells on nanoparticles modified sheets showed perfect expansion. (3) CCK-8 assay showed that the titanium sheets had no obvious cytotoxicity, and the cell proliferation rate of the nanoparticles modified titanium sheets displayed higher rates of proliferation than that of the dopamine coated and pure titanium sheets with increasing cell culture time (P < 0.05). (4) Alkaline phosphatase activity was highest on the surfaces of nanoparticles modified sheets. Immunofluorescence showed that the fluorescence intensity of alkaline phosphatase was strongest. (5) The results showed that the sustained-release coating of aspirin loaded chitosan nanoparticles on the titanium surfaces could enhance the proliferation and adhesion of rat bone marrow mesenchymal stem cells and promote osteogenic differentiation. Figures and Tables | References | Related Articles | Metrics

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Effect of three abutment materials on bone stress around maxillary angle implant under dynamic loading Wang Junxiang, Sun Jiangwei, Bai Bujiafu·Yellisi, Wang Zhaoxin, Nijati·Turson 2023, 27 (3):  398-405.  doi: 10.12307/2023.012 Abstract ( 513 )   PDF (2580KB) ( 93 )   Save BACKGROUND: In oral implant restoration, patients with single missing maxillary anterior teeth often have alveolar bone absorption and defect due to different reasons. To avoid the risk of bone grafting, inclined implants are often used to avoid the alveolar bone absorption area. The angle abutment is used to restore the normal overcovering relationship of patients. The size and distribution of the influence of different abutment materials on the occlusal force transfer of the implant and the surrounding bone were studied.   OBJECTIVE: To compare the influence of time on the peak value of bone stress around the implant with three abutment materials under simulated dynamic loading under three implantation conditions.   METHODS: Cone beam CT data of a healthy adult undergoing implant restoration of maxillary central incisor were selected. Minics software was used to cut the jaw bone. Solidworks 2018 was used to establish the implant, jaw bone, and angle abutment (angle 0°, 15°, and 25°).  Base stations materials included pure titanium, zirconium dioxide, and alumina), central screw, and zirconium dioxide full porcelain crown model. Assembly was complete, for embedded in the original maxillary fang root cutting direction 0° angle, then simulated palate to tilt 15° and 25°, no implanted implant thread exposure. According to different implant angles, they were divided into 0°, 15°, and 25° groups. Dynamic loading was performed for 0.2 seconds, to obtain the time-dependent relationship between the peak value of equivalent stress of bone around the implant prosthesis of each material abutment.   RESULTS AND CONCLUSION: (1) All abutment implant restorations had the same peak distribution of surrounding bone stress when they were subjected to occlusal force, all of which were located in the bone cortex of the implant neck. The fastest time period for the increase of bone stress around abutment implant restorations of each material was within 0.025-0.05 seconds. The range of high stress value of cortical bone in the 15° group was larger than that in the 0° group. The initial stress value of cortical bone of implant in the 25° group was significantly higher than that of the other two groups. The residual stress value of cortical bone was higher after loading. After titanium abutment implantation, the bone stress around the prosthesis had the largest increase, and the range of high stress value was relatively concentrated. (2) In the 15° group, the peak value of bone stress around the implanted prosthesis on the abutment of the three materials was located in the neck of the implant. The increase in bone stress around the titanium abutment implanted prosthesis was relatively large but not obvious, and the distribution range of high stress was relatively consistent. Compared with the other two groups, the high stress value of the 25° group was more concentrated; the initial stress value was higher and the range of change was greater, among which the bone stress around the implanted prosthesis on the dialumina abutment increased the most within 0-0.1 seconds. At 0.2 seconds, the peak value of bone equivalent stress of zirconia abutment decreased to 0, and high residual stress remained in the bone around the implants of the other two abutments. (3) It is concluded that based on the analysis of the distribution of different influences of the implant angle and abutment material on the bone interface, the bone stress of the implants using zirconia abutment was relatively stable at all time points in the three groups.   Figures and Tables | References | Related Articles | Metrics

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Preparation of hyperoside nanoparticles to repair endometrial injury Li Yue, Lyu Yan, Feng Wanying, Song Yang, Yan Yu, Guan Yongge 2023, 27 (3):  360-366.  doi: 10.12307/2023.045 Abstract ( 556 )   PDF (2324KB) ( 38 )   Save BACKGROUND: Hyperoside has many pharmacological effects such as anti-inflammation and anti-oxidation, but there are few studies on its application in repairing endometrial injury.  OBJECTIVE: To prepare hyperoside nanoparticles and to study the repairing effect of poloxamer 407 carrying hyperoside nanoparticles on endometrial injury in model rats.  METHODS: Hyperoside nanoparticles, poloxamer 407 hydrogel and poloxamer 407 hydrogel with hyperoside nanoparticles were prepared separately. Twenty-four female SD rats were randomly divided into four groups (n=6): model group, blank control group, hydrogel group, and drug-loaded hydrogel group. Rat models of endometrial injury were established by scratching method in the model group, hydrogel group and drug-loaded hydrogel group. PBS, poloxamer 407 hydrogel and poloxamer 407 hydrogel with hyperoside nanoparticles were injected into the uterus of rats in the model group, hydrogel group and drug-loaded hydrogel group. The blank control group received only laparotomy without modeling. The model was taken 7 days after the injection. The morphological changes of rat endometrium were observed by hematoxylin-eosin staining. The expression of interleukin-1β, interleukin-8, and tumor necrosis factor-α in the endometrial tissue of rats in each group was detected by ELISA. Immunofluorescence staining was used to detect the expression of vascular endothelial growth factor, keratin and vimentin in endometrial tissue. RESULTS AND CONCLUSION: (1) Hematoxylin-eosin staining showed that compared with the blank control group, the endometrial layer of the rats in the model group became thinner, the endometrial structure was incomplete, and the blood vessels and glands were significantly reduced and sparse. Compared with the model group, the endometrium of the rats in the hydrogel group was thickened and the endometrial structure was relatively complete. The endometrial structure of the rats in the drug-loaded hydrogel group was thickened, the endometrial structure was relatively complete, and the glands were more abundant. (2) Compared with the blank control group, the levels of interleukin-1β, interleukin-8, and tumor necrosis factor-α were all increased in the model group (P < 0.01). Compared with the model group, the levels of interleukin-1β, interleukin-8, tumor necrosis factor-α decreased in the hydrogel group and drug-loaded hydrogel group (P < 0.01). (3) Immunofluorescence staining showed that compared with the blank control group, the expression levels of vascular endothelial growth factor, keratin and vimentin were decreased in the model group (P < 0.01). Compared with the model group, the expression levels of vascular endothelial growth factor, keratin and vimentin were all increased in the drug-loaded hydrogel group (P < 0.01), and the expression of vascular endothelial growth factor was increased in the poloxamer 407 group (P < 0.01). (4) These results confirm that hydrogel carrying hyperoside nanoparticles has a repairing effect on the rat endometrial injury model.  Figures and Tables | References | Related Articles | Metrics

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Evaluation of immunotoxicity of the absorbable macroporous polysaccharides composite hemostatic material Wu Lihao, Shao Anliang, Xu Lin, Ren Kang, Wang Hongjian, Chen Liang, Xu Ling 2023, 27 (3):  329-334.  doi: 10.12307/2022.901 Abstract ( 483 )   PDF (1358KB) ( 79 )   Save BACKGROUND: Our previous studies manifested that the absorbable macroporous polysaccharides composite hemostatic material has a good hemostatic effect, but its immunotoxicity has not been further studied. OBJECTIVE: To evaluate the immunotoxicity of absorbable macroporous polysaccharides composite hemostatic materials in mice.  METHODS: The 48 BALB/c mice were randomly divided into four groups (n=12). No material was implanted in the subcutaneous capsule in the sham-operated group. Mice in the experimental 1 group were implanted with absorbable macroporous polysaccharides composite hemostatic materials without purification in the subcutaneous capsule. Mice in the experimental 2 group were implanted with absorbable macroporous polysaccharides composite hemostatic materials with purification in the subcutaneous capsule. Mice in the control group were implanted with compound microporous polysaccharide hemostatic powder. At 14 and 28 days after implantation, mass and organ/body weight ratio of the heart, liver, spleen, lungs, kidney, adrenal gland, thymus, testis and epididymis, serum IgG and IgM concentraions, proportion of B cells and T cells in spleen lymphocytes, and pathological changes of spleen and thymus were analyzed.  RESULTS AND CONCLUSION: (1) During the experiment, the mice with implanted material were in good condition without obvious poisoning reaction. (2) On day 14 after implantation, the heart weight of the experimental 1 group was higher than that in the sham-operated group (P < 0.05). Lung organ weight and coefficient were lower in the control group than those in the sham-operated group (P < 0.05). Kidney organ weight and coefficient were higher in the experimental 2 group than those in the sham-operated group (P < 0.05). At 14 and 28 days after implantation, other organ weight and coefficient were not significantly different between the experimental 1, 2, and control groups and sham-operated group (P > 0.05). (3) IgM concentration was lower in the experimental 2 group than that in the sham-operated group at 14 days (P < 0.05). IgG concentration was higher in the experimental 1 group than that in the sham-operated group at 28 days (P < 0.05). (4) At 14 and 28 days after implantation, the proportion of B cells and T cells in spleen lymphocytes was not significantly different between the experimental 1 and 2 groups and control group (P > 0.05). (5) At 14 and 28 days, hematoxylin-eosin staining showed slight chronic inflammation in the experimental 1, 2, and control groups. The degree of inflammatory reaction was experimental 2 group < experimental 1 group < control group. (6) These findings verify that absorbable macroporous polysaccharides composite hemostatic material has a low immunotoxicity.  Figures and Tables | References | Related Articles | Metrics

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Wear properties of dental ceramics Bi Jintong, Hu Xin, Liu Jinshu 2023, 27 (3):  406-412.  doi: 10.12307/2023.046 Abstract ( 520 )   PDF (914KB) ( 87 )   Save BACKGROUND: Ceramic materials are widely used in the field of prosthodontics because of their excellent mechanical properties, good biocompatibility with oral tissues, and high aesthetic properties. Good wear properties have important clinical significance for prosthodontics. OBJECTIVE: To review the mechanisms and clinical studies on the wear properties of ceramic materials for prosthodontics in order to provide ideas for the clinical selection of suitable ceramic materials. METHODS: A computer search was conducted on PubMed and Web of Science databases for studies involving the wear properties of dental restorative ceramic materials between January 2016 and April 2021. The English search terms were “dental ceramic material; wear property”. Finally, 36 articles were included for analysis.  RESULTS AND CONCLUSION: (1) The wear resistance of all-ceramic materials was higher than that of resin-ceramic composites. Among the all-ceramic materials, zirconia had the best wear properties and weaker aesthetic properties. (2) Among glass ceramics, zirconia-reinforced lithium silicate glass ceramic has better wear property, but the clinical application time is short, and the long-term efficacy needs more experimental research. (3) Among the resin-ceramic composites, nano-ceramic resin materials have better wear properties than ceramic-polymer. (4) Zirconia can be chosen for full-crown restorations in the posterior region, and high-translucent zirconia ceramics or glass ceramics can be chosen for full-crown restorations in the anterior region, depending on the patient’s aesthetic needs. (5) Veneers, inlays and onlays restorations can be selected from feldspathic porcelain, glass ceramic and resin-ceramic composites, but resin-ceramic composites have poor wear resistance and need to be avoided for high stress bearing areas. (6) Nano-ceramic resin can be considered for patients with exposed dentin, fluorosis and dental erosion, but experimental studies of suitable ceramic materials for these patients are scarce. (7) Surface roughness has a significant effect on the wear properties of ceramic materials, and good polishing in clinical applications can improve the wear properties of ceramic materials, and regular review of the restorations is essential.  Figures and Tables | References | Related Articles | Metrics

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Application of 3D printing technology in the precise and personalized treatment of cleft lip and palate Jiang Haifang, Liu Rong, Hu Peng, Chen Wei, Wei Zairong, Yang Chenglan, Nie Kaiyu 2023, 27 (3):  413-419.  doi: 10.12307/2023.022 Abstract ( 660 )   PDF (1024KB) ( 71 )   Save BACKGROUND: The clinical application of 3D printing technology provides an effective auxiliary means for precise and personalized treatment of cleft lip and palate. OBJECTIVE: To summarize the application status of 3D printing in the diagnosis and treatment of cleft lip and palate, and look forward to the application prospect of 3D printing technology in the precise and personalized treatment of cleft lip and palate. METHODS: CNKI, Wanfang and PubMed databases were searched by computer, with “cleft lip, cleft palate, cleft lip and palate, 3D Printing” as Chinese retrieval terms, and “cleft lip, cleft palate, printing, three-dimensional” as English retrieval terms. A total of 77 relevant articles were retrieved, and 68 articles were finally included for summary and induction according to inclusion and exclusion criteria, including the classification, treatment and application status of 3D printing technology of cleft lip and palate.  RESULTS AND CONCLUSION: (1) In the preoperative (postoperative) orthodontic and shaping, 3D printing offers personalized treatments. With the increase of bioactivator, a variety of correctional implement new strategy of manufacturing appeared, including the use of new materials and coatings, so that 3D printing and correcting device has bacteriostatic action, which enhances the treatment effect. However, the strength, hardness and long-term effectiveness of orthodontic materials need to be further explored. (2) In the process of surgical planning and simulation, 3D printed guide and computer-aided virtual surgery system were introduced to plan surgical guidelines, which helped the surgeon to perform surgical operations more accurately and reduced the difficulty of surgery. However, the auxiliary treatment mainly targeted at bone tissue and played a weak role in the soft tissue of cleft lip and palate. (3) In the art of the implants, biological materials with personalized tissue engineering structure are hot research materials for implantation and repair of bony fissures in patients with cleft lip and palate due to good bone guide, bone regeneration, and the three-dimensional space structure that fits the bone tissue. However, its biocompatibility and safety in the treatment process are not in-depth study. (4) In terms of surgical training and education, 3D printed anatomical models can help medical workers better learn the theoretical knowledge and surgical skills related to cleft lip and palate, and they can also serve as a good tool for doctor-patient communication. (5) Therefore, 3D printing technology, computer-aided virtual surgery system, and personalized biological materials with tissue engineering structure for treatment of cleft lip and palate can promote the transformation from experience treatment to personalized and precise treatment of cleft lip and palate, and achieve the treatment effect of cleft lip and palate. Figures and Tables | References | Related Articles | Metrics

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Meniscal injury repair methods for non-blood supply area Ning Ziwen, Wang Xu, Shi Zhengliang, Qin Yihua, Wang Guoliang, Jia Di, Wang Yang, Li Yanlin 2023, 27 (3):  420-426.  doi: 10.12307/2022.835 Abstract ( 556 )   PDF (906KB) ( 99 )   Save BACKGROUND: Meniscus plays a key role in the biomechanics and cartilage protection of knee joint, and has multiple functions such as shock absorption, maintaining the stability of the knee joint force line, and reducing the wear and tear of articular cartilage. So far, the effect of surgical repair of meniscal non-blood supply area injury has been poor. If only meniscectomy is performed, the change of the overall mechanical structure of knee joint is easy to accelerate the progress of knee osteoarthritis. Therefore, in recent years, scholars are trying to use different ways to assist the repair of meniscus injury, in order to improve the prognostic effect of meniscal non-blood supply area injuries suture and slow down the progress of knee osteoarthritis.  OBJECTIVE: To summarize the repair treatment of meniscus injury for non-blood supply area in recent years, and look forward to the future development prospect and challenges in this field. METHODS: CNKI, Wanfang, PubMed, and FMRS databases were used for literature retrieval. The retrieval range was from 2005 to 2021. All articles related to meniscus injury repair, including clinical research and tissue engineering research, were included. Finally, 60 articles were included for analysis.  RESULTS AND CONCLUSION: (1) Due to the special anatomical structure of the meniscus, there is a problem of poor blood supply in two-thirds of the medial area of the meniscus, which is difficult to heal after injury. The current methods of auxiliary meniscus injury repair include: microfracture, subpatellar fat pad crushing, mesenchymal stem cells, platelet-rich plasma, and fibrin clot. (2) Different repair methods have their own advantages and disadvantages. As clinical application methods, microfracture and comminution of subpatellar fat pad are easy to operate, but they may cause iatrogenic injury, postoperative pain, and osteoarthritis. Further fine operation to avoid injury is an inevitable topic in clinic. Although mesenchymal stem cells and platelet-rich plasma have shown good effects in basic research, their preparation methods are diverse, their application methods are not fixed, and platelet-rich plasma even has completely opposite clinical effects in clinical application. Therefore, further studying the mechanism of mesenchymal stem cells and platelet-rich plasma to improve meniscus repair potential and standardizing its preparation process and application method are still the next research direction. (3) Fibrin clot has shown good results in clinical application, but there is still a lack of more relevant research. (4) In conclusion, there are still few research contents on fibrin clot technology and comminution of subpatellar fat pad, while platelet-rich plasma has appeared polarization in clinical manifestations. Microfracture and clinical application of synovial mesenchymal stem cells are stable, which is a good supplementary method at present. Figures and Tables | References | Related Articles | Metrics

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Application of biological materials in vital pulp therapy Wang Ziyang, Zuo Enjun 2023, 27 (3):  427-433.  doi: 10.12307/2023.024 Abstract ( 871 )   PDF (913KB) ( 138 )   Save BACKGROUND: Studies have shown that the retention rate of endodontically treated teeth (especially molars) is significantly lower than that of vital teeth. The hazard ratios for loss were 7.4:1. With the progress of the concept of tissue regeneration and the development of biological materials, people are searching for new endodontic treatments to increase the retention rates. OBJECTIVE: To review the clinical effect, application status and research prospect of various biological materials in order to help clinicians choose a better method in vital pulp therapy.  METHODS: Based on Chinese search terms “vital pulp therapy, calcium hydroxide, MTA, iRoot BP Plus, Biodentine, TheraCal LC, BioAggregate”, the authors searched and matched relevant documents in CNKI and Wanfang database. With the English search terms “vital pulp therapy, MTA, iRoot BP Plus, Biodentine, TheraCal LC, BioAggregate”, the authors searched for relevant literature in PubMed database. The retrieval time was from January 2011 to November 2021. After reading title, abstract and full-text selection of literature, 56 articles were finally included for review. RESULTS AND CONCLUSION: (1) In minimally invasive endodontics, in addition to pursuing the integrity of residual dental hard tissues, healthy dental pulp should be retained as far as possible. Preservation of vital pulp is important to both immature permanent teeth and mature permanent teeth. It can help to improve prognosis and increase the retention rates. (2) Calcium hydroxide is the longest-used pulp capping agent in clinic. Its effect is stable and the price is low, but it cannot seal the pulp tightly. There are tunnel-like defects in the dentin bridge of the patients, and the prognosis is poor. (3) The biocompatibility of mineral trioxide aggregates is better than that of calcium hydroxide, with good sealing properties, which can effectively control inflammation. There are problems such as high price, long coagulation time, and possible discoloration of the crown. (4) In recent years, new biomaterials such as iRoot BP Plus, Biodentine, TheraCal LC, and BioAggregate have gradually entered the clinic, showing bright prospects. Further clinical research is still needed. However, no matter what pulp capping material is used, accurate selection of indications is the key to successful preservation of healthy pulp tissue.  Figures and Tables | References | Related Articles | Metrics

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Advances and biological application of asymmetric dressings Zhou Jie, Pei Xibo, Wan Qianbing 2023, 27 (3):  434-440.  doi: 10.12307/2023.027 Abstract ( 685 )   PDF (1353KB) ( 101 )   Save BACKGROUND: It has been a consensus to use wound dressings to protect and promote wound healing after debridement, but now there is no ideal multi-functional dressing that can simulate the skin structure. Asymmetric dressings can mimic the skin structure to the greatest extent, resistant to infection, control the water vapor exchange and promote the efflux of exudate. Therefore, asymmetric dressings have a great potential to become a kind of ideal wound dressings. OBJECTIVE: To summarize the latest research progress and biological application of asymmetric dressings. METHODS: The literature search was performed in PubMed, Web of Science, CNKI and Wanfang databases, and the keywords were “asymmetric dressing, wound asymmetric membrane, wound asymmetric film” in Chinese and English. The articles were screened according to the inclusion and exclusion criteria. Finally, 53 articles were included for review.  RESULTS AND CONCLUSION: Asymmetric dressings can simulate the structure of human skin, besides, its density hydrophobic layer can prevent invasion of external bacterium and control the exchange of water vapor. The hydrophilic layer is able to load and release the required drugs. The porous structure is conducive to cell proliferation and adhesion, thus promoting wound healing. The asymmetric characteristics do not significantly affect the physical properties of the asymmetric dressings, but these dressings are usually composed of multiple materials, resulting in better properties than single material. According to their structural characteristics, current asymmetric dressings can be divided into three types: single-layer modified asymmetric dressings, double-layer asymmetric dressings and gradient asymmetric dressings. In the future work, asymmetric dressings will be endowed with more and more intelligent functions and will be further developed as a potential ideal skin substitute, to solve the problems faced by traditional dressings in clinical application. Figures and Tables | References | Related Articles | Metrics

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Research progress in platelet-rich fibrin in stomatology Chen Jingqiao, Li Ying, Meng Maohua, Xu Xingxing, Wang Qinying, Wang Huan, Lu Jing, Shu Jiayu, Dong Qiang 2023, 27 (3):  441-446.  doi: 10.12307/2023.047 Abstract ( 391 )   PDF (866KB) ( 55 )   Save BACKGROUND: Platelet-rich fibrin is a second-generation platelet concentrate that has been applied in many fields of dentistry. However, there is no conclusive evidence to explain its effect on promoting the healing and preservation of soft and hard tissues. OBJECTIVE: To review the current research overview of platelet-rich fibrin in stomatology. METHODS: Relevant literature published from 2001 to 2021 was searched in CNKI and PubMed databases with the search terms of “platelet-rich fibrin, stomatology” in Chinese and English, respectively. The search time limit was extended for some classical literature. The abstracts and contents of the retrieved literature were analyzed, and 53 eligible documents were obtained as per inclusion and exclusion criteria.  RESULTS AND CONCLUSION: Although it has been documented that platelet-rich fibrin has a good effect in the repair and reconstruction of soft and hard tissues in oral diseases, the current evidence does not clearly explain the mechanism. In addition, the preparation methods of platelet-rich fibrin are not yet the same and there are a wide variety of platelet-rich fibrin derivatives and different centrifugation methods. Therefore, a large number of experiments are still needed in the future. Figures and Tables | References | Related Articles | Metrics

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Application of carboxymethyl chitosan in tissue engineering of stomatology Zong Mingrui, Liu Haiyan, Li Bing, Wu Xiuping 2023, 27 (3):  447-452.  doi: 10.12307/2023.019 Abstract ( 796 )   PDF (895KB) ( 171 )   Save BACKGROUND: As a derivative of natural biological material chitosan, carboxymethyl chitosan has a wide application prospect in tissue engineering due to its unique water-solubility, film-forming and sustained-release properties.   OBJECTIVE: To review the advantages of carboxymethyl chitosan compared with chitosan and its application in oral tissue regeneration.   METHODS: PubMed and CNKI were searched using the key words of “carboxymethyl chitosan AND Tissue engineering, carboxymethyl chitosan AND (dentistry OR stomatology)” for articles published from January 2006 to October 2021. Preliminary screening was conducted through reading and analysis to exclude duplicate articles and low-correlation articles. Eventually, 51 articles were included for result analysis.  RESULTS AND CONCLUSION: Carboxymethyl chitosan, as a non-toxic material with valuable biocompatibility and biodegradation, has made ideal progresses in bone tissue regeneration, tooth tissue regeneration and periodontal tissue regeneration. Carboxymethyl chitosan has better water solubility, membrane formation and ion binding properties than chitosan, which greatly expands its application in oral tissue engineering. Carboxymethyl chitosan has achieved the expected experimental results whether it is used alone to exert antibacterial effect and promote cell proliferation and differentiation, or used as a scaffold material, hydrogel, modified material and biological active ingredients and growth factors. Figures and Tables | References | Related Articles | Metrics

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Influencing factors and mechanism of nanoparticle renal targeting Li Zhen, Liu Hongbao 2023, 27 (3):  453-460.  doi: 10.12307/2023.048 Abstract ( 831 )   PDF (1145KB) ( 55 )   Save BACKGROUND: Drugs for treating kidney diseases can be quickly eliminated in the body, and it is difficult to reach the kidney in sufficient quantity. Moreover, there are systemic side effects, repeated attacks and other problems. Nanoparticles have attracted more and more attention in targeted drug delivery. At present, there are more and more researches focusing on its influencing factors and potential mechanisms. OBJECTIVE: To sum up the influencing factors and potential mechanisms of nanoparticle renal targeting. METHODS: The related research on nanoparticle kidney-targeted drug delivery system was searched on PubMed and CNKI databases by computer. The English search terms were “Nanoparticles, kidney target” and the Chinese search terms were “kidney target”. The retrieval time was from June 2016 to June 2021. RESULTS AND CONCLUSION: (1) Nanoparticles with negative charge, high aspect ratio, strong water solubility, high flexibility, high density, certain dose, intravenous administration route, bionic functional simulation, surface modified aptamer antibody and other fragments are all factors that increase the targeted accumulation of kidney. (2) Factors affecting passive targeting, such as size and charge, are related to the mechanical barrier and charge barrier of kidney itself. (3) The factors affecting active targeting are related to the connection of nanoparticles with aptamers, antibody fragments and peptides. The potential mechanism is that these polymers combine with specific receptors on renal tubules to achieve the purpose of active targeting. (4) The potential mechanisms of factors affecting the half-life of nanoparticles in renal targeted circulation include: nanoparticles entering the body can realize the escape of endosomes/lysosomes. The compact folded structure of nanoparticles exposes less enzymes/proteins, isolates the liver, and reduces the chance of forming protein halo. Strong water solubility can be conjugated or absorbed to the surface of nanoparticles to form corona and provide spatial stability. The filamentous nanoparticles with stronger flexibility are aligned with the fluid, and the flexible tail escapes the contact of macrophages and is attracted by hydrodynamic shear force, thus escaping internalization. Higher density nanoparticles circulate more slowly, resulting in slower kidney clearance. Intravenous administration and serine modification can increase the targeted accumulation of nanoparticles in kidney. (5) Although there have been preliminary studies on the imaging diagnosis of non-tumor kidney diseases, acute kidney injury, renal fibrosis, polycystic kidney, glomerulonephritis, and nephrotic syndrome, they are still in the stage of animal experiment, and there are still great challenges in applying these results to clinical practice in the future.  Figures and Tables | References | Related Articles | Metrics

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Use of expanders and implants in breast reconstruction complicated with infection Wang Kaiyu, Hu Peng, Wei Zairong, Huang Guangtao, Zhou Jian, He Guijia, Nie Kaiyu 2023, 27 (3):  461-469.  doi: 10.12307/2023.049 Abstract ( 456 )   PDF (1313KB) ( 88 )   Save BACKGROUND: With the improvement of women’s aesthetic and therapeutic needs, breast reconstruction has become a commonly used treatment option after breast cancer surgery, of which the use of expanders and implants is high. Infection, as the most common complication with the use of expanders and implants, can lead to a range of consequences and even affect the results of breast reconstruction. With the deep understanding of the risk factors leading to infection in breast reconstruction, the continuous improvement of treatment options and the application of new materials, the occurrence of infection can be reduced and the success rate of breast reconstruction can be improved. OBJECTIVE: To summarize the risk factors, prevention and treatment measures of infection associated with the use of expanders and implants in breast reconstruction, and to introduce the application prospects of new materials in breast reconstruction. METHODS: Related articles were retrieved on CNKI, Wanfang, PubMed, and Web of Science databases. Search terms were “tissue expander, breast implants, breast reconstruction, infection” in Chinese and English. According to the inclusion and exclusion criteria, after preliminary screening of articles, 119 articles with high relevance and reference value were reviewed.  RESULTS AND CONCLUSION: (1) Breast reconstruction based on tissue expanders and implants is widely used in clinical practice, and multiple risk factors may lead to the occurrence of infection after breast reconstruction and, in severe cases, to the loss of expanders and implants. (2) Breast reconstruction expanders and implants are subdivided into multiple types according to different material characteristics, of which the roughness of surface is an important cause affecting the occurrence of infection. Although the smooth surface has a higher incidence of seroma than the textured surface, drainage is usually taken in advance to avoid the risk of infection caused by seroma in clinical practice. (3) Clinicians need to carefully evaluate the probability of infection and reasonably select expanders or implants in combination with the health status and treatment methods of breast reconstruction patients. For example, for patients with multiple preoperative infection factors, the selection of smooth surface expanders or implants may be more conducive to the prevention and control of infection. (4) Second-generation cephalosporins can be used to prevent infection after reconstruction, and can be used in combination with quinolones when necessary. For patients who have shown signs of infection, it is necessary to timely select bacteria-sensitive antibiotics for treatment according to bacterial culture and drug sensitivity test, and preserve expanders or implants for patients as far as possible. (5) At present, some studies have developed new breast reconstruction materials and drug coatings. Because such products have their own advantages of antibacterial and inhibition of bacterial attachment, they can fundamentally reduce the incidence of expander and implant infection and have shown positive therapeutic effect in some clinical case studies. However, further randomized controlled trials with large samples are needed to verify it in the future.  Figures and Tables | References | Related Articles | Metrics

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Advantages and problems of antibiotic-loaded bone cements for bone and joint infections Han Tao, Hao Jianqiang, Li Wenbo, Shi Jie, Gao Qiuming 2023, 27 (3):  470-477.  doi: 10.12307/2023.034 Abstract ( 1372 )   PDF (949KB) ( 80 )   Save BACKGROUND: Polymethyl methacrylate bone cement has good stability, plasticity and space-occupying ability, and is currently the most commonly used antibiotic carrier in clinical practice. Topical application of antibiotic-loaded bone cements can prevent, delay or even eradicate infections in the skeletal muscular system, and is currently a common means of addressing the challenge of bone and joint infections. However, the addition of antibiotics can significantly affect the mechanical properties of polymethyl methacrylate bone cement and has the potential to cause adverse reactions. In addition, some scholars found that the antibiotic release rate of antibiotic-loaded bone cements is very low, and topical application of antibiotic-loaded bone cements does not effectively destroy bacteria and has the potential to cause bacterial resistance. Therefore, they questioned the effectiveness of antibiotic-loaded bone cements in controlling infections, and it has been widely debated. OBJECTIVE: To review the advantages and problems of antibiotic-loaded bone cements and to summarize the precautions for its clinical use.  METHODS: The computerized searches were conducted on PubMed, Wanfang and CNKI databases using “antibiotic-loaded bone cements, polymethyl methacrylate, PMMA; bone cements, anti-bacterial agents, bone and bones, joints, elution, release, and mechanical” as the search terms in Chinese and English to search the relevant literature from January 1, 2017 to December 31, 2021. After excluding the literature that was not related to the article content, poorly innovative and duplicated, 68 papers were finally included for review. RESULTS AND CONCLUSION: Currently, antibiotic-loaded bone cements are one of the best options for the treatment of bone and joint infections. As research on antibiotic-loaded bone cements continues, many new methods have emerged to improve their antibiotic release, antimicrobial capacity and mechanical properties, and their use in clinical practice has also expanded. However, there are still many issues that have not been solved and further research is needed, such as the selection of antibiotics, dosage, and the optimal mixing method. In addition, the development and local application of modified materials and antibiotic substitutes that can be incorporated into polymethyl methacrylate bone cement are expected to solve the problem of bacterial resistance. It is believed that with the development of medicine, pharmacology and biomaterials science, polymethyl methacrylate bone cement will be more widely used in clinical practice.  Figures and Tables | References | Related Articles | Metrics

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Application of functional peptides for biomedical diagnosis Wu Tong, Yin Caiyun, Zhao Mingzhe, Zhu Yishen 2023, 27 (3):  478-485.  doi: 10.12307/2023.063 Abstract ( 799 )   PDF (1188KB) ( 128 )   Save BACKGROUND: As a class of biomaterials with excellent biocompatibility and biodegradability, functional peptides are becoming a research hotspot in the field of biomedicine. OBJECTIVE: To review the current development and future prospects of functional peptides in the field of biomedical diagnosis. METHODS: Search words were “peptides, self-assembly force, medicine imaging, biomaterials, medical diagnosis” in English and Chinese. Computer was used to retrieve relevant articles on self-assembled peptide medical diagnosis in VIP, Wanfang, CNKI, Web of Science, and PubMed databases from 2000 to 2020, and systematic induction, summary and analysis were conducted. RESULTS AND CONCLUSION: (1) The bonding forces for constructing self-assembled structures include van der Waals forces, hydrophobic interactions, electrostatic interactions, as well as the biological recognition of peptides. (2) The application of functional peptides in the field of biomedical diagnosis includes optical imaging, photoacoustic imaging, magnetic resonance imaging, computer tomography, and radionuclide imaging. (3) Functional peptides specifically target tumor sites in vivo for tumor imaging and treatment, with good targeting, high specificity, and strong binding affinity to receptors. (4) The functional peptides can be activated in situ by temperature and light to activate aggregation, complete multifunctional diagnosis of specific parts, good imaging effect, no toxic side effects, and fast metabolism in the body. (5) Functional peptides are labeled to enhance the detection signal in the body, monitor small changes, and perform disease diagnosis and preventive treatment. (6) It can be found that functional peptides have very broad application prospects in biomedical diagnosis, such as tumor detection and treatment, imaging of specific parts, and enhancement of detection signals. Figures and Tables | References | Related Articles | Metrics

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Systematic evaluation of six dressings on wound safety following total hip and knee arthroplasty You Aijia, Li Wenjie, Zhou Junli, Li Chun 2023, 27 (3):  486-492.  doi: 10.12307/2023.029 Abstract ( 572 )   PDF (1320KB) ( 125 )   Save OBJECTIVE: In recent years, the operation rate of total hip and knee arthroplasty has been increasing, and postoperative wounds need to be covered with dressings to protect newborn skin tissues. Choosing a high-safety medical dressing is an important issue at present. This study systematically evaluated the safety of six kinds of medical dressings on wounds after total hip and knee arthroplasty. METHODS: The computer search was conducted on CNKI, Wanfang, VIP and China Biomedical Literature Database, PubMed, Embase, Web of Science, Cochrane Library and Scopus. Clinical studies of different medical dressings applied to wound after total hip and knee arthroplasty were collected. The search time was from the database establishment to December 2021. Two researchers independently screened the literature and extracted the data. Using Stata 16.0 and RevMan 5.4 software, the blister rate of the primary outcome measure was analyzed by network meta-analysis. The infection rate, dressing change times and erythema of the secondary outcome measures were analyzed by meta-analysis. RESULTS: (1) A total of 20 included studies contained 14 randomized controlled trials and 6 cohort studies involving 6 474 patients and 6 dressings, i.e., conventional dressings, thin film dressings, foam dressings, silver ion dressings, hydrophilic fiber silver-containing dressings, and alginate dressings. (2) The results of the network meta-analysis showed that in terms of reducing postoperative wound blister rate, which ranked as follows: alginate dressing (98.6%) > hydrophilic fiber silver dressing (75.4%) > film dressing (45.0%) > foam dressing (37.4%) > silver ion dressing (26.3%) > traditional dressing (2.0%). (3) The results of direct meta-analysis showed that hydrophilic fiber silver dressing was superior to traditional dressing in reducing postoperative wound infection rate and dressing change times [OR=0.36, 95%CI(0.23,0.58), P < 0.05; MD=-1.85, 95%CI(-2.40, -1.30), P < 0.000 01]. There was no statistical significance in reducing postoperative wound erythema (P > 0.05).  CONCLUSION: For patients after total hip and knee arthroplasty, alginate dressing has the best overall effect on reducing the rate of postoperative blisters, while hydrophilic fiber silver-containing dressing has the best overall effect on reducing the number of postoperative dressing changes and infection rate. Therefore, these two dressings should be given priority after total hip and knee arthroplasty, and more high-quality randomized controlled trials are needed to confirm this conclusion.  Figures and Tables | References | Related Articles | Metrics