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    18 June 2024, Volume 28 Issue 17 Previous Issue    Next Issue
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    Calcium phosphate combined with recombinant human bone morphogenetic protein-2 in repair and reconstruction of tibial infectious bone defects
    Jia Xufeng, Long Miao, Huang Guangping, Zhong Qing, Zhang Zhaoyao, Qi Yuxin, Tian Peng, Li Ping, Chen Yuchi
    2024, 28 (17):  2625-2630.  doi: 10.12307/2024.475
    Abstract ( 139 )   PDF (927KB) ( 17 )   Save
    BACKGROUND: Although the clinical application of Masquelet technology has achieved extensive success, the research on optimizing all aspects of Masquelet technology is still being carried out. The focus of doctors is to speed up bone healing and shorten bone healing time after bone grafting.
    OBJECTIVE: To observe the effect of calcium phosphate combined with recombinant human bone morphogenetic protein-2 in repairing tibial infectious bone defects.
    METHODS: Thirty-one patients with tibial infectious bone defects were selected from The People’s Hospital of Jianyang City from June 2017 to June 2022. They were treated with the Masquelet membrane induction technique. During the second stage of operation, they were divided into a control group (n=15) and a study group (n=16) according to different bone graft materials. Patients in the control group were implanted with autologous bone/allogeneic bone particles, and those in the study group were implanted with calcium phosphate combined with recombinant human bone morphogenetic protein-2/autologous bone particles. Six months after the second stage operation, peripheral blood inflammatory indexes such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were detected. Imaging bone healing time, bone healing X-ray score, bone defect healing classification, and adjacent joint function were recorded. The presence of nail track infection, implant absorption, pain, and infection in the bone extraction area were observed.
    RESULTS AND CONCLUSION: (1) White blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels of the two groups 6 months after the second stage operation were significantly lower than those before the first stage operation (P < 0.05). There was no significant difference in each index between the two groups (P > 0.05). (2) Bone healing time in the study group was shorter than that in the control group (P < 0.05). (3) The Samantha X-ray score of the study group 6 months after the second stage operation was higher than that of the control group (P < 0.05). The excellent and good rate of bone defect healing and adjacent joint function of the study group was higher than that of the control group (P < 0.05). There was no significant difference in the recurrence rate and complication rate between the two groups (P > 0.05). (4) These findings indicate that the effect of calcium phosphate combined with recombinant human bone morphogenetic protein-2 during the second stage operation of the Masquelet membrane induction technique in the treatment of tibial infectious bone defect is good and safe.
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    Preparation of heparinized acellular vascular scaffold and hemocompatibility evaluation
    Li Xiafei, Zhao Lingling, Liang Feng, Zhang Xuewei, Zhang Jinjin, Lin Fei, Yang Tuo, Zhao Liang
    2024, 28 (17):  2631-2636.  doi: 10.12307/2024.479
    Abstract ( 156 )   PDF (1254KB) ( 54 )   Save
    BACKGROUND: Acellular vascular scaffolds can mimic the microstructure and function of native blood vessels, but some extracellular matrix loss occurs during their preparation, which affects their hemocompatibility. Therefore, it is necessary to modify them to improve their hemocompatibility.
    OBJECTIVE: To assess the hemocompatibility of acellular vascular scaffold prepared by Triton-x100/heparin sodium treatment. 
    METHODS: The abdominal aorta was taken from SD rats and randomly divided into control and experimental groups. The control group was treated with Triton-x100 for 48 hours. The experimental group was treated with Triton-x100 for 48 hours and then treated with heparin sodium. The morphology and hydrophilicity of the two groups of acellular vascular scaffolds were detected. The hemocompatibility of the two groups of acellular vascular scaffold was evaluated by recalcification coagulation time test, platelet adhesion test, dynamic coagulation time test, hemolysis test, and complement activation test. 
    RESULTS AND CONCLUSION: (1) Scanning electron microscopy showed that the surface of the two groups of vascular scaffolds was relatively intact, and a large number of fiber filaments appeared on the surface of the scaffolds after decellularity treatment, and the surface microstructure changed significantly. The water contact angle of the two groups of vascular scaffolds was smaller than that of natural vessels (P < 0.000 1). There was no significant difference in water contact angle between the two groups (P > 0.05). (2) The coagulation time of vascular scaffold was longer in the experimental group than in the control group (P < 0.05). The number of platelets attached to the scaffold membrane was less in the experimental group than that in the control group (P < 0.000 1). The coagulation index was greater in the experimental group than that in the control group (P < 0.01), and the complement level was lower in the experimental group than that in the control group (P < 0.001). The hemolysis rate of the two groups was lower than 5% of the national standard. (3) To conclude, acellular scaffold treated with Triton-x100/heparin sodium has excellent hemocompatibility.
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    Antibiotic-loaded bone cement in treatment of calf compartment syndrome caused by diabetic foot necrotizing fasciitis
    Xu Peng, Xue Mingyu, Rui Yongjun, Bu Fanyu, Guo Xiaofeng, Xie Yikai
    2024, 28 (17):  2637-2641.  doi: 10.12307/2024.441
    Abstract ( 153 )   PDF (1042KB) ( 17 )   Save
    BACKGROUND: At present, the treatment methods for necrotizing fasciitis mostly use negative pressure sealing suction after thorough debridement. This method requires repeated debridement to completely remove necrotic infected tissue, causing serious physical and economic burdens to patients.
    OBJECTIVE: To introduce a rare clinical case of calf compartment syndrome caused by diabetic foot necrotizing fasciitis, and summarize the clinical experience of using antibiotic-loaded bone cement for treatment and comprehensive management.
    METHODS: A total of 6 patients with calf compartment syndrome caused by diabetic necrotizing fasciitis admitted to Wuxi 9th Affiliated Hospital of Soochow University from August 2017 to August 2020 were selected, including 5 males and 1 female with an average age of 54 years. During the perioperative period, the patients’ general condition was evaluated and systemic nutritional support treatment was given. In the first stage, all patients received complete debridement to control infection, antibiotic-loaded bone cement packing, and negative pressure sealed drainage. In the second stage, bone cement was removed and wound repair was performed. The wound healing, as well as the occurrence of redness, swelling, and exudation was observed during the follow-up.
    RESULTS AND CONCLUSION: (1) The wounds of four patients were fresh after twice antibiotic-loaded bone cement packing, and the membrane formation was good, and one patient was good after three times of antibiotic-loaded bone cement packing, and the wounds of all five patients healed well after the second stage of skin grafting. Due to the difficulty in maintaining intraoperative blood pressure and infection in all four compartments of the lower leg, a patient underwent emergency knee amputation. Meanwhile, the stump wound was placed with antibiotic-loaded bone cement. The wound was closed directly after the secondary bone cement was removed, and the wound healed in the first stage. (2) The six patients were followed up for 6-24 months after discharge. At the last follow-up, all six patients had good wound healing and no symptoms such as redness, swelling, and exudation. The quality of life of the patients was significantly improved, and all of them were satisfied with the curative effect. (3) The occurrence of calf compartment syndrome should be vigilant when diabetic foot necrotizing fasciitis is highly suspected. Early diagnosis and timely incision decompression are of great importance. Besides, the application of antibiotic-loaded bone cement in the treatment of calf compartment syndrome caused by diabetic necrotizing fasciitis has a good short-term effect.
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    Effect of biotic amniotic membrane and corneal bandage lens on corneal wound repair after pterygium surgery
    Wang Shijuan, Chen Wensheng, Tang Hui
    2024, 28 (17):  2642-2646.  doi: 10.12307/2024.476
    Abstract ( 178 )   PDF (900KB) ( 19 )   Save
    BACKGROUND: It has been reported that the application of biotic amniotic membrane and corneal bandage lens in pterygium surgery can significantly reduce the pain reaction after pterygium excision and promote the healing of corneal wounds.
    OBJECTIVE: To compare the efficacy of biotic amniotic membrane and corneal bandage lens on the repair of corneal wounds and neuropathic pain after pterygium surgery. 
    METHODS: A total of 121 cases (142 eyes) of primary pterygium patients admitted to Nanyang Second People’s Hospital from August 2020 to May 2022 were retrospectively selected. They all underwent pterygium excision combined with autogenous free conjunctival flap transplantation. Among them, 63 cases (68 eyes) of pterygium postoperative wound repair with biotic amniotic membrane were classified as the amniotic membrane group, and 58 cases (74 eyes) of pterygium wound repair with corneal bandage lens were classified as the bandage lens group. Postoperative follow-up was conducted, and the corneal wound repair of the patients within 2 weeks after surgery was recorded. Neuropathic pain was quantified by Wong-Baker face on the day after surgery, 1 day, and 2 weeks after surgery. The corneal topographic map indicating asymmetry index, best corrected visual acuity, corneal refractive index, and surface rule index were recorded before surgery, 1 and 3 months after surgery. 
    RESULTS AND CONCLUSION: (1) 2 weeks after treatment, the wound repair rate in the bandage lens group was significantly higher than that in the amniotic membrane group (P < 0.05). The wound healing time was shorter in the bandage lens group than that in the amniotic membrane group (P < 0.01). (2) The degree of neuropathic pain in the bandage lens group was lower than that in the amniotic membrane group on the day and 1 day after surgery (P < 0.001), and there was no significant difference between the two groups in neuropathic pain at 2 weeks after surgery (P > 0.05). (3) The corneal topographic map indicating asymmetry index, best corrected visual acuity, corneal refractive index, and surface rule index were significantly improved in both groups 1 and 3 months after surgery (P < 0.05). The corneal topographic map indicating asymmetry index, corneal refractive index, and surface rule index of the bandage lens group were lower than those of the amniotic membrane group 1 and 3 months after surgery (P < 0.05). (4) Recurrence occurred in 1 eye (1.47%) in the amniotic membrane group and 3 eyes (4.05%) in the bandage lens group within 3 months after operation, and there was no significant difference between the groups (P > 0.05). (5) These findings suggest that the corneal bandage lens is more effective than the biotic amniotic membrane in the repair of corneal wounds after pterygium surgery.
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    Application of different grafts in anterior cruciate ligament revision
    Liu Guoli, Li Liang, Xie Kunnan, Yin Xianghui, Zhang Yanrui, Yi Fan, Dai Shifeng
    2024, 28 (17):  2647-2652.  doi: 10.12307/2024.471
    Abstract ( 160 )   PDF (986KB) ( 79 )   Save
    BACKGROUND: The type of graft selected during anterior cruciate ligament revision is considered one of the main factors affecting the postoperative outcome, but there are few reports on the comparison between different graft materials.
    OBJECTIVE: To explore the medium-to-long-term clinical efficacy after anterior cruciate ligament revision with autologous ligament, allogeneic ligament, and LARS artificial ligament. 
    METHODS: A total of 67 patients with the first anterior cruciate ligament revision admitted to the Department of Joint and Sports Medicine, The Second Hospital of Tangshan from May 2011 to May 2020 were selected, including 41 males and 26 females, with a mean age of (45.83±7.39) years. They were divided into three groups according to different grafts used: autologous ligament group (n=24), allogeneic ligament group (n=22), and LARS artificial ligament group (n=21). Follow-up for more than 36 months after revision was performed to evaluate the effect of revision. 
    RESULTS AND CONCLUSION: (1) International Knee Documentation Committee (IKDC) score, Lysholm knee score, and Tegner motor score 1 year after surgery and at the last follow-up in the three groups were higher than those before surgery (P < 0.05). There were no significant differences in IKDC score, Lysholm knee score, and Tegner motor score among the three groups 1 year after surgery and the last follow-up (P > 0.05). (2) The lateral differences of KT-1000 at 1 year after surgery and the last follow-up among the three groups were lower than those before surgery (P < 0.05). The lateral difference of KT-1000 and the positive rate of the axial shift test in the last follow-up of the LARS artificial ligament group were higher than those in the autologous ligament group and allogeneic ligament group (P < 0.05). (3) At the last follow-up, X-ray films showed no obvious enlargement of the reconstructed bone tunnel and no obvious failure of the graft fixation device. There was no obvious aggravation of osteoarthritis, but bone density decreased significantly in some elderly patients. (4) These findings suggest that anterior cruciate ligament revision with LARS artificial ligaments can obtain good initial stability, but with the extension of time, the stability of partial cases tends to decrease, even with reconstructed ligament failure. Both allogeneic and autogenous ligaments can obtain good clinical efficacy in anterior cruciate ligament revision.
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    Strontium-containing mesoporous bioactive glass nanoparticles loaded with bisphosphonates ameliorate bone loss in ovariectomized mice
    Zhou Zhi, Chen Zhijie, Huo Shicheng, Li Zhanchun
    2024, 28 (17):  2653-2658.  doi: 10.12307/2024.482
    Abstract ( 161 )   PDF (1974KB) ( 39 )   Save
    BACKGROUND: Inhibition of osteoclast activity by bisphosphonates slows the progression of osteoporosis. However, serious complications of bisphosphonates, such as osteonecrosis of the jaw and atypical femur fracture, limit the clinical application of bisphosphonates. Effective alternative therapies need to be sought to improve existing clinical dilemmas.
    OBJECTIVE: To prepare strontium-containing mesoporous bioactive glass nanoparticles loaded with bisphosphonates (BPS@Sr-MBG) and analyze its activity against bone loss. 
    METHODS: Strontium-containing mesoporous bioactive glass nanoparticles (Sr-MBG) were prepared by sol-gel method and added to alendronate saturated solution for the preparation of BPS@Sr-MBG. (1) Cell experiment: Mouse bone marrow macrophages were inoculated in 96-well plates and supplemented with ɑ-MEM complete culture medium containing macrophage colony stimulating factor and activator-ligand of nuclear factor κB receptor for osteoclast induced differentiation experiment. Meanwhile, they were cultured in three groups. The blank group was added with PBS. The control group was added with bisphosphonate, and the experimental group was added with BPS@Sr-MBG. After 5 days of culture, the differentiation of osteoclasts was observed by F-actin ring staining. (2) Animal experiments: Twenty-four female C57/BL mice were randomly divided into four groups with six mice in each group. Except sham operation group, ovariectomy group, BPS group and BPS@Sr-MBG group were used to construct osteoporosis model. One week after model establishment, mice in BPS group and BPS@Sr-MBG group were intraperitoneally injected with bisphosphonate solution and BPS@Sr-MBG solution, respectively. Mice in the sham operation group and ovariectomy group were intraperitoneally injected with PBS once a week. After 8 weeks of continuous injection, mouse femurs were taken for Micro-CT scanning and hematoxylin-eosin staining.
    RESULTS AND CONCLUSION: (1) Cell experiment: F-actin ring-formation staining demonstrated that compared with blank group, the area proportion and number of osteoclasts in the control group were decreased (P < 0.01). Compared with the control group, the area proportion of osteoclasts and the number of osteoclasts in the experimental group were decreased (P < 0.01). (2) Animal experiments: Micro-CT scanning results of femur showed that compared with the sham operation group, bone density, trabecular bone volume fraction, trabecular thickness and trabecular number of mice in the ovariectomy group were decreased (P < 0.05, P < 0.01), while trabecular distance and structural model index were increased (P < 0.01). Compared with the ovariectomy group, the above bone parameters in the BPS group and BPS@Sr-MBG group were significantly improved (P < 0.01), and the improvement in the BPS@Sr-MBG group was more obvious. The Micro-CT scanning results were further confirmed by hematoxylin-eosin staining of the femur. (3) The results show that BPS@Sr-MBG can exert anti-osteoporosis activity through anti-osteoclastic effect and promoting bone formation.
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    Platelet-camouflaged silver nanoparticle hydrogel accelerates wound healing in type 1 diabetic rats
    Wang Jinlei, Li Ke, Zhao Liang
    2024, 28 (17):  2659-2666.  doi: 10.12307/2024.450
    Abstract ( 148 )   PDF (3850KB) ( 40 )   Save
    BACKGROUND: Bacterial infections and impaired angiogenesis have been obstacles to diabetic wound healing, and the problem of multidrug resistance cannot be ignored, so there is an urgent need to find a new therapeutic strategy.
    OBJECTIVE: To prepare platelet-camouflaged silver nanoparticle hydrogel and observe its therapeutic effect on diabetic wounds. 
    METHODS: (1) In vitro test: The ultra-small silver nanoparticles (usAgNPs) were obtained by reflux heating. usAgNPs-PL/CMC hydrogel was prepared by coupling it with platelets (PL) and adding it to the carboxymethyl cellulose (CMC) hydrogel. The microstructures, swelling properties, and mechanical properties of the hydrogel were characterized. The antibacterial activity of the hydrogel was tested by 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)5[(phenylamino)carbonyl]-2H-tetrazolium hydroxide method, reactive oxygen species method, bacterial biofilm method, and bacterial activity. (2) In vivo test: Forty SD rats were randomly divided into sham operation group, model group, CMC hydrogel group, usAgNPs/CMC hydrogel group, and usAgNPs-PL/CMC hydrogel group, with eight rats in each group. The type 1 diabetes model was established in the other four groups except the sham operation group. After successful model establishment, a skin wound (20 mm in diameter) deep to the fascia layer was made on the back of rats of the five groups. Rats in the sham operation group and model group were injected with normal saline. The rats in the CMC hydrogel group, usAgNPs/CMC hydrogel group, and usAgNPs-PL/CMC hydrogel group were implanted with the corresponding hydrogel, separately. The wound healing condition and healing quality were observed after 14 days of treatment. 
    RESULTS AND CONCLUSION: (1) In vitro test: The usAgNPs-PL/CMC hydrogel had a uniform three-dimensional network structure, good mechanical properties, and strong water absorption ability, which could remarkably inhibit the growth of Escherichia coli and Staphylococcus aureus, and had a good inhibition and clearance effect on the formation of biofilms of the two bacteria, and had a good antibacterial ability. (2) In vivo test: After 14 days of treatment, the wounds of the usAgNPs-PL/CMC hydrogel group were basically closed. The wound healing rate was the highest, and the number of wound colonies was significantly lower than that of the model group. After 14 days of treatment, hematoxylin-eosin and Masson staining showed that the tissue structure of regenerated dermis appeared on the wounds of the usAgNPs-PL/CMC hydrogel group, usAgNPs/CMC hydrogel group, and CMC hydrogel group, and the epidermis of the new granulation tissue was complete and thick. Parallel mature collagen fibers were observed in the usAgNPs-PL/CMC hydrogel group. After 7 days of treatment, CD31 immunohistochemistry and Ki67 immunofluorescence staining showed that the usAgNPs-PL/CMC hydrogel group had the highest number of microvessels and fibroblasts. (3) The results showed that usAgNPs-PL/CMC hydrogel could accelerate wound healing in type 1 diabetic rats by rapidly inhibiting bacteria and promoting angiogenesis.
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    Polycaprolactone-polydopamine-AOPDM1 scaffold promotes bone formation in a high-glucose environment
    Liu Ziyang, Lao An, Xu Chenci, AiRi Shin, Wu Jiaqing, Liu Jiaqiang
    2024, 28 (17):  2667-2674.  doi: 10.12307/2024.480
    Abstract ( 145 )   PDF (2368KB) ( 71 )   Save
    BACKGROUND: Oral and maxillofacial bone tissue defects can seriously affect the physical and mental health of patients. When bone defects occur in diabetic patients, bone metabolism disorders caused by abnormal blood sugar make it more difficult to repair and treat. 
    OBJECTIVE: To attempt to apply AOPDM1, a polypeptide with potential bioactivity to the osteogenic treatment of diabetic patients. 
    METHODS: In normal or high-glucose environment, different concentrations of AOPDM1 were used to interfere with mouse bone marrow mesenchymal stem cells, and cell proliferation, alkaline phosphatase activity, mineralization nodules formation and osteogenic differentiation gene expression were detected. The polycaprolactone scaffold was prepared by electrospinning technology, and the scaffold was modified by polydopamine to prepare the polycaprolactone-polydopamine composite scaffold. Finally, the scaffolds were placed in AOPDM1 solution to prepare polycaprolactone-polydopamine-AOPDM1 scaffolds. The water contact angle and mechanical properties of the scaffolds were tested in the three groups. In normal or high-glucose environment, the three groups of scaffolds were co-cultured with mouse bone marrow mesenchymal stem cells, respectively, and cell adhesion, alkaline phosphatase activity and osteopontin expression were detected. 
    RESULTS AND CONCLUSION: (1) Compared with normal environment, high-glucose environment inhibited the proliferation of bone marrow mesenchymal stem cells. In the same environment, AOPDM1 could promote the proliferation of mouse bone marrow mesenchymal stem cells. When AOPDM1 concentration was the same, alkaline phosphatase activity, mineralization ability and mRNA expression of type I collagen, osteopontin, alkaline phosphatase, and Runx2 of bone marrow mesenchymal stem cells were decreased in high-glucose environment compared with normal environment. Under the same environment, AOPDM1 could improve the alkaline phosphatase activity, mineralization ability, and mRNA expression of type I collagen, osteopontin, alkaline phosphatase and Runx2 of bone marrow mesenchymal stem cells. (2) The hydrophilicity of polycaprolactone-polydopamine scaffold and polycaprolactone-polydopamine-AOPDM1 scaffold was higher than that of polycaprolactone scaffold (P < 0.001), and there was no significant difference in tensile strength and elastic modulus among the three groups (P > 0.05). Compared with the other two groups of scaffolds, the cells on the polycaprolactone-polydopamine-AOPDM1 scaffold had better adhesion morphology. When the scaffolds were identical, compared with normal environment, high-glucose environment inhibited alkaline phosphatase activity and osteopontin expression of bone marrow mesenchymal stem cells. When the environment was the same, the alkaline phosphatase activity and osteopontin expression of bone marrow mesenchymal stem cells on the polycaprolactone-polydopamine-AOPDM1 scaffold were higher than those on the other two scaffolds. (3) The above results prove that polycaprolactone-polydopamine-AOPDM composite scaffold can promote the osteogenic properties of bone marrow mesenchymal stem cells in high-glucose environment.
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    Recombinant expression and in vitro activity identification of a bioactive peptide QUB2984 from skin secretion of Agalychnis callidryas
    Tang Ziyan, Gu Shunqiang, Chen Xiaoling, Wang Lei, Ma Chengbang, Zhou Mei, Chen Tianbao, Du Lina, Jin Yiguang
    2024, 28 (17):  2675-2681.  doi: 10.12307/2024.445
    Abstract ( 170 )   PDF (1425KB) ( 20 )   Save
    BACKGROUND: Frog active peptides have rich activities, such as antibacterial and anti-tumor, and are expected to solve the problem of antibiotic resistance.
    OBJECTIVE: The active peptide QUB2984 was discovered in the skin secretions of Agalychnis callidryas. Its structure and properties were simulated by bioinformatics. The peptide was synthesized, purified, and identified and its biological functions were investigated.
    METHODS: Agalychnis callidryas skin secretions were collected by electrostimulation. The sequence of QUB2984 was obtained through constructing a cDNA library with isolated mRNA. BLAST was used for peptide sequence alignment. Besides that, Iterative Threading ASSEmbly Refinement (I-TASSER) and HeliQuest tools were used for protein secondary structure simulation. It was synthesized by solid-phase peptide synthesis, purified by reverse-phase high-performance liquid chromatography, and structurally confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The purified peptide was used to evaluate its biological activity. Its antibacterial effect was evaluated by the minimum inhibitory concentration method. Its cytotoxic effect was detected by MTT assay. Its safety was investigated by a hemolysis test.
    RESULTS AND CONCLUSION: (1) Peptide QUB2984 had basically α-spiral structure, with a relatively intact hydrophobic surface, and a certain destructive ability to biofilm. The third amino acid position of QUB2984 was composed of W and had a G-X-G structure. (2) The minimum inhibitory concentration of QUB2984 against gram-positive Staphylococcus aureus was 2 μmol/L, the minimum inhibitory concentration against gram-negative Escherichia coli was 2 μmol/L, and the minimum inhibitory concentration against the fungus Candida albicans was 8 μmol/L. (3) The active peptide QUB2984 had obvious inhibitory effect on human non-small cell lung cancer cells NCI-H838 at 10-5 mol/L concentration, and the hemolytic effect on horse red cells at 64 μmol/L concentration was 50%. (4) The results showed that QUB2984 had anti-bacterial and anti-cancer activity, and it had a positive charge of +3, which was conducive to contact with bacteria or cells.
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    Preparation and osteoinductivity of piezoelectric polyvinylidene fluoride foam-based scaffold
    Qin Siyu, Song Li, Chen Junyu, Li Yijun, Wan Qianbing
    2024, 28 (17):  2682-2689.  doi: 10.12307/2024.472
    Abstract ( 169 )   PDF (2668KB) ( 31 )   Save
    BACKGROUND: Bone is a remarkable natural material possessing piezoelectric properties. By harnessing the biomimetic piezoelectric effect, tissue engineering materials can be employed to effectively address bone tissue defects and facilitate their repair.
    OBJECTIVE: Using a solid-phase force chemistry technique, a piezoelectric scaffold with inherent osteogenic properties was meticulously fabricated. This unique scaffold was then assessed for its impact on osteoblast adhesion, proliferation, and osteogenic differentiation.
    METHODS: Polyvinylidene fluoride (PVDF) powders, along with commercially available NaCl (mass ratios are 60:40, 50:50, 40:60, and 30:70, respectively), were subjected to solid-phase shear milling technology, resulting in a homogenous mixture. Through a melting process, a substantial material was formed, and subsequent treatment with a pure water solution effectively eliminated the NaCl. Consequently, PVDF piezoelectric foam scaffolds with varying pore sizes were successfully prepared. These materials were categorized as PVDF-40, PVDF-50, PVDF-60, and PVDF-70, denoting the respective mass percentages of NaCl during preparation. The surface morphology, crystal phase composition, thermodynamic behavior, mechanical properties, and piezoelectric properties of each group were meticulously characterized. The four kinds of piezoelectric foam scaffolds were co-cultured with the MG63 osteoblast cell line to evaluate its biocompatibility and potential to promote bone differentiation. 
    RESULTS AND CONCLUSION: (1) The scanning electron microscopy, four groups of scaffolds had multi-level pores. As the NaCl mass fraction in the mixed powder increased, the porosity of the scaffolds increased. X-ray energy dispersion spectrum, X-ray diffraction, Fourier transform infrared spectroscopy, and thermogravimetric analysis collectively revealed the scaffold predominantly comprised the α phase, which inherently lacked piezoelectric properties. However, the application of solid-phase force chemistry successfully stimulated the formation of the β phase, thereby enhancing the scaffold’s piezoelectric properties. Notably, the PVDF-60 group exhibited the highest proportion of the β phase among all the tested groups. The results of cyclic compression testing and piezoelectric performance assessment demonstrated that the PVDF-60 group exhibited superior compressive strength and piezoelectric performance compared to the other groups. (2) The findings from scanning electron microscopy and laser confocal microscopy exhibited that MG63 cells adhered well to the surface of the four groups of scaffolds, with good morphology, extended more pseudopods, and secreted a large amount of extracellular matrix. CCK-8 assay revealed that the proliferative absorbance of PVDF-60 cells cultured for 4 days was higher than that of the other three groups (P < 0.000 1). Alkaline phosphatase staining and alizarin red staining showed that the expression of alkaline phosphatase and the number of calcified nodules in the PVDF-60 group were higher than those in the other three groups (P < 0.01, P < 0.000 1). (3) The piezoelectric PVDF  foam-based scaffolds demonstrated favorable cytocompatibility. Notably, the PVDF-60 group showed superior mechanical properties, piezoelectric performance, and bone-inducing capabilities.
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    Human beta-defensin 3 hydrogel for treatment of periodontitis in rats
    Wang Yuxue, Zhou Xin, Zheng Junyuan, Zhou Yongqing
    2024, 28 (17):  2690-2695.  doi: 10.12307/2024.448
    Abstract ( 80 )   PDF (1646KB) ( 63 )   Save
    BACKGROUND: Previous studies have shown that human beta-defensin 3 has significant antifungal, antibacterial, and antiviral activities and plays an important bridging role in linking innate and acquired immune responses. 
    OBJECTIVE: To observe the effect of human beta-defensin 3 hydrogel on treatment of periodontitis in rats.
    METHODS: Using Poloxamer 188 and 407 as the matrix, a blank hydrogel was constructed by cold solution. Human beta-defensin 3 hydrogel was prepared by mixing human beta-defensin 3 with the hydrogel. Twenty-five SD rats were randomly divided into five groups with five rats in each group: No treatment was given in the healthy group. The periodontitis model was constructed by the orthodontic ligature wire method in the periodontitis group, blank hydrogel group, minocycline hydrochloride group, and human beta-defensin 3 hydrogel group. 8 weeks after modeling, blank hydrogel, minocycline hydrochloride, and human β-defensin 3 hydrogel were injected into the buccal and palatal periodontal bags, once a week, and relevant tests were carried out after continuous administration for 4 weeks.
    RESULTS AND CONCLUSION: (1) Compared with the healthy group, periodontal plaque index, gingival bleeding index, and periodontal probing depth were increased in the periodontitis group (P < 0.01). Compared with the periodontitis group, the periodontal plaque index, gingival bleeding index, and periodontal probing depth of rats were decreased in the minocycline hydrochloride group and the human beta-defensin 3 hydrogel group (P < 0.05). (2) Hematoxylin-eosin staining proved that the hydrogel was not toxic to the rat organism. (3) Stereomicroscopy and Micro CT showed that compared with the healthy group, the root exposure and the distance between enamel cementum boundary and alveolar crest of the periodontitis group were increased (P < 0.05). Compared with the periodontitis group, the root exposure and the distance between enamel cementum boundary and alveolar crest of rats were reduced in the minocycline hydrochloride group and human beta-defensin 3 hydrogel group (P < 0.05). (4) Hematoxylin-eosin, Masson, and tartrate-resistant acid phosphatase staining showed that periodontal inflammation was obvious, fiber structure was disordered and osteoclasts were active in the periodontitis group and blank hydrogel group, while periodontal inflammation was decreased, fiber arrangement was more regular, and osteoclasts were reduced in the minocycline hydrochloride group and human beta-defensin 3 hydrogel group. (5) qRT-PCR showed that compared with the healthy group, the mRNA expressions of interleukin 1β, tumor necrosis factor α, interleukin 6, and inducible nitric oxide synthase were increased in the periodontitis group (P < 0.05). Compared with the periodontitis group, the mRNA expressions of interleukin 1β, tumor necrosis factor α, interleukin 6, and inducible nitric oxide synthase in gingival tissue of rats were decreased in the minocycline hydrochloride group and human beta-defensin 3 hydrogel group (P < 0.05). (6) The results showed that human beta-defensin 3 hydrogel was able to attenuate inflammation in rat periodontal tissues by decreasing the relative expression of inflammatory factors and inhibiting osteoblasts. 
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    Effect of domestic porous tantalum modified by osteogenic induction factor slow-release system on function of MG63 cells
    Guo Xiaoling, Li Yueyuan, Xu Tianjie, Zhang Hui, Wang Zhiqiang, Wang Qian
    2024, 28 (17):  2696-2701.  doi: 10.12307/2024.410
    Abstract ( 135 )   PDF (1426KB) ( 69 )   Save
    BACKGROUND: Previous research by the research team found that domestically produced porous tantalum is beneficial for early adhesion and proliferation of MG63 cells, and can be used as a scaffold material for bone tissue engineering.
    OBJECTIVE: To investigate the effect of domestic porous tantalum modified by osteogenic induction factor slow-release system on the adhesion, proliferation, and differentiation of MG63 cells. 
    METHODS: Osteogenic induction factor slow-release system was constructed by adding 15% volume fraction of osteogenic factor solution to poly(lactic-co-glycolic-acid) gel. The passage 3 MG63 cells were inoculated on a porous tantalum surface (control group), porous tantalum surface coated with poly(lactic-co-glycolic-acid) copolymer gel (gel group), and porous tantalum surface coated with osteoblastic induction factor slow-release system (slow-release system group), and co-cultured for 5 days. The surface cytoskeleton of the material was observed by phalloidine staining. Cell proliferation was detected by flow cytometry. Western blot assay and RT-qPCR were used to detect the protein and mRNA expressions of type I collagen, osteopontin, and RUNX-2 on the surface cells of the material.
    RESULTS AND CONCLUSION: (1) Phalloidine staining showed that MG63 cells adhered to and grew on the surface and inside of the three groups of porous tantalum, and the matrix secreted by the cells covered the surface of the material. (2) Flow cytometry showed that the cell proliferation in the slow-release system group was faster than that in the control group and the gel group (P < 0.05). (3) Western blot assay and RT-qPCR showed that the protein and mRNA expressions of type I collagen, osteopontin, and RUNX-2 in the slow-release system group were higher than those in the control group and gel group (P < 0.05). (4) The results showed that the domestic porous tantalum modified by the osteogenic induction factor slow-release system was beneficial to the adhesion, proliferation, and differentiation of MG63 osteoblasts.
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    Low-temperature condensation deposition method for 3D printing of bone tissue engineering poly-L-lactic acid/pearl powder composite scaffold
    Gang Fangli, Shi Rui, Ma Chunyang, Xiao Yi
    2024, 28 (17):  2702-2707.  doi: 10.12307/2024.474
    Abstract ( 148 )   PDF (1690KB) ( 64 )   Save
    BACKGROUND: The repair of large-scale bone defects is still facing serious challenges. It is of great significance to develop personalized, low-cost, and osteogenic-inducing tissue engineering scaffolds for bone repair.
    OBJECTIVE: To explore the process of 3D printing bone tissue engineering scaffold containing pearl composite material by low-temperature condensation deposition method, and further test the physicochemical properties and in vitro biological functions of the composite scaffold. 
    METHODS: Pearl powder was prepared by grinding and sieving. The pearl powder of different qualities was added into the poly-L-lactic acid ink, so that the mass ratio of pearl powder to poly-L-lactic acid was 0, 0.1, 0.2, 0.3, and 0.5, respectively. The 3D-printed poly-L-lactic acid/pearl powder scaffolds were prepared using the low-temperature condensation deposition method. The microstructure, compressive properties, water contact angle, cytocompatibility, and in vitro bone differentiation ability of the printed poly-L-lactic acid/pearl powder composite scaffolds were detected. 
    RESULTS AND CONCLUSION: (1) Scanning electron microscopy showed that the five groups of scaffolds all had micropores with a diameter of 2 μm or even smaller, irregular shapes and interconnectivity. (2) All the five groups had good compressive properties. The compressive strength of the pearl powder 0.5 group was higher than that of the other four groups (P < 0.05). The water contact angle of the pearl powder 0.2 group and the pearl powder 0.5 group was smaller than that of the pearl powder 0 group (P < 0.01, P < 0.001). (3) Bone marrow mesenchymal stem cells were co-cultured with five groups of scaffolds for 1, 3, and 5 days, respectively. The cell proliferation in pearl powder 0.1, 0.2, 0.3, and 0.5 groups cultured for 3 and 5 days was faster than that in pearl powder 0 group (P < 0.05). After 1 day of culture, live-dead staining exhibited that the number of cells on the scaffold was small, but all of them were living cells. (4) Bone marrow mesenchymal stem cells were inoculated on the scaffold surface of the pearl powder 0 group and pearl powder 0.1 group respectively for osteogenic differentiation. The alkaline phosphatase activity induced for 4 and 6 days in the pearl powder 0.1 group was higher than that in the pearl powder 0 group (P < 0.05). (5) The results showed that the poly-L-lactic acid/pearl powder composite scaffold had good compressive strength, hydrophilicity, cytocompatibility, and osteogenic properties.
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    Visualization analysis of vascular stimulating scaffolds in bone tissue engineering#br#
    Fang Yuan, Kang Zhijie, Wang Haiyan, Li Xiaohe, Zhang Kai
    2024, 28 (17):  2708-2715.  doi: 10.12307/2024.373
    Abstract ( 147 )   PDF (2576KB) ( 23 )   Save
    BACKGROUND: The study of the physical properties of scaffolds has always been a hot topic in the field of tissue engineering research. However, for vascular stimulating scaffolds, in addition to meeting the basic performance of the scaffold, other methods are also needed to promote the regeneration of blood vessels within the scaffold, in order to achieve the ultimate goal of repairing bone tissue.
    OBJECTIVE: A visualization analysis was carried out on the literature published in and outside China on scaffold stimulation for bone tissue engineering, to explore the research hotspots and research status in this field, and to provide a reference for subsequent studies.
    METHODS: Using the CNKI database and Web of Science core database as retrieval databases, the relevant literature on vascular scaffolds for bone tissue engineering was retrieved. The literature that did not conform to the research object was removed. The obtained data were imported into CiteSpace 6.1.R2 software. Visualization analysis was performed on authors, national institutions, and keywords in the research field. 
    RESULTS AND CONCLUSION: (1) China, the United States, and Germany were the top three countries with the most articles on scaffold stimulation for bone tissue engineering. (2) The top 3 institutions in the CNKI database were Southern Medical University, Huazhong University of Science and Technology, and Donghua University. In the core database of Web of Science, Shanghai Jiao Tong University, Sichuan University and Chinese Academy of Sciences ranked the top 3 in terms of the number of institutional publications. (3) The top 3 keywords in the CNKI database were “tissue engineering, vascularization, angiogenesis”. The top 3 keywords in the Web of Science core database were “mesenchymal stem cell, scaffold, vascularization”. (4) Through the analysis of co-citation and highly cited references, the main concerns were as follows: vascularization strategies: scaffold design, angiogenic factor delivery, in vitro co-culture, and in vivo pre-vascularization. Technology: 3D printing, electrospinning, vascular transplantation, vascular fusion. Mechanisms: immune regulation and macrophages, drug/growth factor delivery, the relationship between endothelial cells and osteoblasts, the paracrine relationship between bone cells and endothelial cells, signaling molecular pathways, angiogenesis, and anti-angiogenesis molecules. (5) The researches concerning vascular stimulating scaffolds in bone tissue engineering in and outside China attach great importance to the application of stem cells and 3D printing technology. Current research focuses on biological 3D printing technology, scaffold modification methods, and the development and application of intelligent biomaterials based on bone repair mechanisms.
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    Influential mechanism of graphene and its derivatives on angiogenesis and vascularized bone
    Gao Li, Liu Liu, Ren Wenyan, Liu Xue, Wang Yiyu
    2024, 28 (17):  2716-2722.  doi: 10.12307/2024.483
    Abstract ( 162 )   PDF (1124KB) ( 51 )   Save
    BACKGROUND: Graphene is the thinnest, strongest, and toughest type of two-dimensional new crystal material, demonstrating significant advantages in biomedical applications. Angiogenesis and vascularization of bone are key factors in tissue repair and regeneration, and are effective ways to address vascular and osteogenic issues. 
    OBJECTIVE: To review the characteristics and mechanisms of graphene and its derivatives in promoting angiogenesis activity and vascularizing bone, in order to provide a reference for their clinical application in vascular tissue repair and regeneration. 
    METHODS: Using a computer to search for relevant literature included in PubMed, ScienceDirect, CNKI, and Wanfang databases, the Chinese search terms were “grapheme”, “angiogenesis, vascularization”, “vascularized bone”, and “endothelial cells”, while the English search terms were “graphene” “angiogenesis OR vascularization” “vascularized bone” “endothelial cells”. After excluding literature unrelated to the topic of the article, according to the inclusion and exclusion criteria, 62 articles were ultimately included for result analysis.
    RESULTS AND CONCLUSION: (1) At present, graphene oxide has been studied more and is the most widely used in graphene and its derivatives. (2) Graphene and its derivatives are suitable for heart, bone, nerve, and wound healing related diseases. (3) Graphene and its derivatives have excellent physical and chemical properties and biological properties, but they have potential cytotoxicity. We should pay attention to its biological safety in application. (4) The application of graphene and its derivatives requires further research to demonstrate the optimal size and concentration and measures to reduce toxicity. (5) On the cellular level, graphene and its derivatives can promote angiogenic activity by tip endothelial cell phenotype, mesenchymal stem cell adhesion and proliferation, and vascular smooth muscle cell growth. (6) On the molecular level, graphene and its derivatives can increase the expression of vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor and activate reactive oxygen species/nitric oxide synthase/nitric oxide signaling pathway, lysophosphatilate R6/Hippo-YAP pathway, stromal cell-derived factor-1/vascular endothelial growth factor and ZEB 1/Notch1 pathway. (7) Grapheme oxide and graphene oxide-copper phosphorylated extracellular regulatory protein kinase and activated hypoxia-inducible factor-1, thereby promoting the up-regulation of vascular endothelial growth factor and bone morphogenetic protein-2 expression, and promoting angiogenesis and vascularized bone. (8) In summary, graphene and its derivatives, especially graphene oxide, have great application prospects in the repair and regeneration of vascularized tissues due to their excellent biological properties, good angiogenesis and vascularized bone ability.
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    Myocardial patch: cell sources, improvement strategies, and optimal production methods
    Hu Wei, Xing Jian, Chen Guangxin, Chen Zee, Zhao Yi, Qiao Dan, Ouyang Kunfu, Huang Wenhua
    2024, 28 (17):  2723-2730.  doi: 10.12307/2024.484
    Abstract ( 150 )   PDF (1203KB) ( 19 )   Save
    BACKGROUND: Myocardial patches are used as an effective way to repair damaged myocardium, and there is controversy over which cells to use to make myocardial patches and how to maximize the therapeutic effect of myocardial patches in vivo.
    OBJECTIVE: To find out the best way to make myocardial patches by overviewing the cellular sources of myocardial patches and strategies for perfecting them.
    METHODS: The first author searched PubMed and Web of Science databases by using “cell sheet, cell patch, cardiomyocytes, cardiac progenitor cells, fibroblasts, embryonic stem cell, mesenchymal stem cells” as English search terms, and searched CNKI and Wanfang databases by using “myocardial patch, biological 3D printing, myocardial” as Chinese search terms. After enrollment screening, 94 articles were ultimately included in the result analysis. 
    RESULTS AND CONCLUSION: (1) The cellular sources of myocardial patches are mainly divided into three categories: somatic cells, monoenergetic stem cells, and pluripotent stem cells, respectively. There are rich sources of cells for myocardial patches, but not all of them are suitable for making myocardial patches, e.g., myocardial patches made from fibroblasts and skeletal myoblasts carry a risk of arrhythmogenicity, and mesenchymal stem cells have a short in vivo duration of action and ethical concerns. With the discovery of induced multifunctional stem cells, a reliable source of cells for making myocardial patches is available. (2) There are two methods of making myocardial patches. One is using cell sheet technology. The other is using biological 3D printing technology. Cell sheet technology can preserve the extracellular matrix components intact and can maximally mimic the cell growth ring in vivo. However, it is still difficult to obtain myocardial patches with three-dimensional structure by cell sheet technology. Biologicasl 3D printing technology, however, can be used to obtain myocardial patches with three-dimensional structures through computerized personalized design. (3) The strategies for perfecting myocardial patches mainly include: making myocardial patches after co-cultivation of multiple cells, improving the ink formulation and scaffold composition in biological 3D printing technology, improving the therapeutic effect of myocardial patches, suppressing immune rejection after transplantation, and perfecting the differentiation and cultivation protocols of stem cells. (4) There is no optimal cell source or method for making myocardial patches, and myocardial patches obtained from a particular cell or technique alone often do not achieve the desired therapeutic effect. Therefore, researchers need to choose the appropriate strategy for making myocardial patches based on the desired therapeutic effect before making them.
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    Application of cell derivative in periodontal regeneration
    Liang Chao, Liao Li, Tian Weidong
    2024, 28 (17):  2731-2738.  doi: 10.12307/2024.242
    Abstract ( 168 )   PDF (1547KB) ( 21 )   Save
    BACKGROUND: Cell derivative is cell-derived bioactive components, including decellularized extracellular matrix, exosome, apoptotic extracellular vesicle, and conditioned medium, has the effects on immune regulation, promoting angiogenesis, bone regeneration, ligament remodeling, and is capable of promoting stem cell chemotherapy, migration, proliferation, and adhesion. Its excellent characteristics make it a promising biomaterial for application and clinical translation in the field of periodontal tissue engineering. 
    OBJECTIVE: To review the characteristics of cell derivatives (decellularized extracellular matrix, exosome, apoptotic extracellular vesicle, and conditioned medium) and its effect and the latest progress in the field of regenerative restoration of periodontal complex tissue structures.
    METHODS: We searched the articles on CNKI and PubMed databases with the search terms “regeneration, periodontal tissue, tissue engineering, decellularized matrix, exosome, apoptotic extracellular vesicle, condition medium” in Chinese and English, respectively. Finally, 76 articles were included for analysis and discussion.
    RESULTS AND CONCLUSION: (1) Among those four cell derivatives, the decellularized extracellular matrix has the best mechanical properties and fibrous structure, serving as a biomimetic scaffold to provide physiochemical signals and participate in mechanical signaling in periodontal tissue engineering, providing supporting effect suitable for periodontal regeneration. Recently, the development of soluble decellularized extracellular matrix bioinks has enabled the fabrication of regenerative scaffolds for personalized periodontal defects. (2) Exosomes are the simplest cell derivatives that have immunomodulatory capacity, promoting cell migration and differentiation. As a carrier, they can be used to carry target molecules to regulate periodontal regeneration, promote ligament remodeling and bone regeneration, and are suitable for periodontal tissue engineering. (3) Apoptotic vesicles generated from apoptotic cells have a strong immunomodulatory effect and can recruit stem cells and macrophages, which determine the fate of stem cells through signal transduction and can enhance immunomodulation to promote periodontal regeneration. Engineered extracellular vesicle is considered to have the potential to initiate targeted internal immunomodulation. (4) The extraction of conditioned medium is simple and completely noninvasive, which provides essential nutrients and growth factors for tissue regeneration. These components are crucial for successful periodontal regeneration. Therefore, the conditioned medium is especially suitable for studying the interactions between cells in vitro and has an important role in high-throughput detection in the future.  
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    Functional characteristics and clinical applications of MXene nanoparticles in wound healing
    Wang Xindong, Liang Chengzhi, Zhang Yongxian
    2024, 28 (17):  2739-2746.  doi: 10.12307/2024.449
    Abstract ( 191 )   PDF (1461KB) ( 44 )   Save
    BACKGROUND: MXene nanoparticles have considerable application prospects as effective functional components of skin wound dressings due to their unique properties of conductivity, hydrophilicity, antibacterial activity, and biocompatibility.
    OBJECTIVE: To review the synthesis methods, functional properties, and application of MXene nanoparticles in skin injury repair.
    METHODS: “MXene, nanoparticles, nanomaterials, bioactive nanoparticles”, “wound dressing, wound dressing, wound repair materials”, “wound repair, wound healing, wound surface” were used as Chinese search terms to search Wanfang and CNKI databases. “MXene, nanoparticles, nano-materials, bioactive nanoparticles”, “wound dressing, wound healing material”, “wound healing, wound repair, wound” were used as English search terms to search the PubMed database. Finally, 88 articles were included for review analysis. 
    RESULTS AND CONCLUSION: (1) MXene synthesis can be divided into two methods: bottom-up synthesis and top-down synthesis. The synthesized MXene can be further modified to enhance biocompatibility for better application in biomedicine. (2) MXene has a series of excellent properties such as hydrophilicity, antibacterial, photothermal properties, electrical conductivity, and good biocompatibility, all of which make it the basis for excellent skin repair materials. (3) At present, many scholars have developed new composite materials for wound dressings. Currently, these composite materials are based on MXene nanomaterials and make full use of its excellent characteristics as mentioned above, which play a role in local skin wound sterilization, drug delivery, and sustained release, active regulation of cytokines, and can integrate the advantages of other biologically active agents. It plays a better role in wound healing, especially in the treatment of complex chronic wounds. (4) Various composite materials such as MXene@PVA hydrogel and MXene@CH sponge developed based on various properties of MXene have shown good effects on improving tissue repair performance and repairing skin damage as drug carriers. It shows that MXenes nanoparticles are in the initial stage of development and have great prospects in the field of promoting skin repair. The characteristics and surface modification of MXenes nanoparticles have been well studied, but the molecular mechanism of dose-dependent biotoxicity is relatively incomplete. 
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    Potential of shikonin and its derivatives in oral soft and hard tissue regeneration
    Bian Zhihong, Zhang Yuntao, Li Zeming, Hou Yudong
    2024, 28 (17):  2747-2752.  doi: 10.12307/2024.446
    Abstract ( 160 )   PDF (866KB) ( 14 )   Save
    BACKGROUND: Shikonin contributes to the promotion of bone defect repair and the treatment of osteoporosis. 
    OBJECTIVE: To summarize the application potential of shikonin and its derivatives in oral soft and hard tissue regeneration. 
    METHODS: A literature review was conducted in databases such as PubMed, Web of Science, Wanfang, China National Knowledge Infrastructure (CNKI), and VIP, spanning articles from 2002 to 2023. The search terms were “shikonin, oral cavity, periodontitis, antibacterial, bone formation, osteoclast, osteoporosis, toxicology” in Chinese and English. 
    RESULTS AND CONCLUSION: Shikonin and its derivatives possess anti-inflammatory effects, inhibit periodontal pathogens such as Porphyromonas gingivalis, promote periodontal wound healing, and regenerate alveolar bone tissue. Shikonin formulations can be used to treat oral diseases such as aphthous ulcers and oral candidiasis. These findings suggest a promising future for shikonin and its derivatives in treating periodontal diseases, preventing oral ailments, and promoting the regeneration of both soft and hard periodontal tissues. Further research is needed to explore how to combine shikonin with tissue engineering to achieve quicker healing of oral soft and hard tissues.
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    Effect of graft type on knee function after anterior cruciate ligament reconstruction
    Li Luyi, Li Xiaojie, Hei Zeming, Liu Hua
    2024, 28 (17):  2753-2758.  doi: 10.12307/2024.478
    Abstract ( 158 )   PDF (898KB) ( 18 )   Save
    BACKGROUND: Grafts are often used to reconstruct the anterior cruciate ligament in clinical practice, while different types of grafts affect postoperative knee function and the development of rehabilitation programs. 
    OBJECTIVE: To retrospectively analyze the effects of different graft types on muscle strength, joint stability, functional activities, and return to sports in patients after anterior cruciate ligament reconstruction.
    METHODS: Related studies were searched through PubMed, Web of Science, Cochrane, CNKI, and WANFANG databases. The Chinese and English key words were “anterior cruciate ligament reconstruction, autografts, allografts, artificial ligaments, bone-patellatendon-bone, quadriceps tendon autograft, hamstring tendon autograft, peroneus longus tendon autograft, rehabilitation, exercise, protocol, return to sport”. 
    RESULTS AND CONCLUSION: Patients with bone-patellar tendon-bone grafts should strengthen centrifugal contraction exercises of quadriceps muscle, and pay attention to the recovery of quadriceps muscle endurance and explosive power in the later stage of rehabilitation. Compared with bone-patellar tendon-bone grafts and hamstring tendon grafts, significantly fewer patients with quadriceps tendon grafts met regression criteria within 5-8 months, and a longer training plan should be developed, with the training cycle lasting as long as possible to more than 3 years. The selection of hamstring tendon grafts should strengthen the hamstring muscle strength training under multiple angles, especially the cycle of bending the knee above 60° until at least 18 weeks after surgery. Patients who choose peroneus longus tendon graft should strengthen the muscle strength around the ankle, mainly the plantar muscle strength. In the selection of allograft, attention should be paid to the reduction of tension resistance of 20% after the graft is disinfected by low-dose radiation, so attention should be paid to knee stability training. Patients who choose artificial ligament grafts can gradually enhance quadriceps and hamstring muscle strength training within 3-6 weeks, pay attention to early proprioceptive exercises, and conduct targeted training on balance, jumping, and flexibility.
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    Research and application of electrospinning drug delivery systems containing traditional Chinese medicine
    Zhang Shuzhi, Qu Pengfei, Han Junquan, Wang Hong
    2024, 28 (17):  2759-2765.  doi: 10.12307/2024.444
    Abstract ( 147 )   PDF (1358KB) ( 124 )   Save
    BACKGROUND: Electrospun porous nanofiber exhibits excellent properties and designability. It is an effective way to control the release of traditional Chinese medicine and improve the bioavailability to design an advanced drug delivery system, which has a broad application prospect.
    OBJECTIVE: To review the construction methods of the electrospinning drug delivery system of traditional Chinese medicine and its related research progress in the medical field.
    METHODS: The literature search was performed in CNKI, PubMed, and Web of Science databases with the search terms “electrospinning, traditional Chinese medicine, drug carrier, drug delivery system, tissue engineering, dressing” in both English and Chinese for articles published from 2013 to 2023. Finally, 62 articles were included in this review.
    RESULTS AND CONCLUSION: (1) The key elements of the electrospinning drug delivery system of Chinese medicine preparation are substrate material, traditional Chinese medicine composition, and drug loading method. (2) The preparation of the electrospinning drug delivery system of Chinese medicine can be carried out according to the application scenario and therapeutic purpose. Firstly, the types of Chinese medicine are selected, then the polymer matrix and solution suitable for them are selected, and finally, the fiber structure is designed according to the drug release requirements and the appropriate drug loading method is adopted. (3) At present, the medicinal agents used are mainly plant Chinese medicine, and there is a lack of systematic research on animal and mineral Chinese medicine. (4) Blended drug loading is the most studied and applied drug loading method, and its drug release characteristics and adaptation scenarios are constantly expanded by optimizing the physicochemical properties of the solution and selecting the diversity of loaded substances. Multilayer fibers with different compositions and properties can be prepared by coaxial, multi-axis, and sequential electrospinning methods, which have broad development prospects. (5) The early application of the electrospinning drug delivery system of Chinese medicine focused on medical dressings according to the antibacterial and hemostatic functions. In recent years, it has been studied in the field of tissue engineering because some components of traditional Chinese medicine can promote cell adhesion, proliferation, and differentiation. (6) At present, the research mainly focuses on the characterization and optimization of loading materials, processes, physicochemical properties, and biological properties, but the research on the mechanism is less. Its clinical application has not been widespread; the adverse reactions in vivo and the interaction between its degradation behavior and drug release behavior are still unknown. (7) Future studies need to consider: We should expand the application of Chinese medicine by improving the physicochemical properties and increasing the purification of Chinese medicine extracts. We need to comprehensively study the therapeutic effects and application mechanisms of Chinese medicine, and clarify the interaction of degradation behavior and drug release behavior, to achieve a more perfect combination and application of Chinese medicine and electrospinning nanofibers under a more accurate mechanism.
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    Application of machine learning in key properties of medical metal materials
    Shi Liu, Liang Pengchen, Chang Qing, Song Erhong
    2024, 28 (17):  2766-2773.  doi: 10.12307/2024.406
    Abstract ( 214 )   PDF (1649KB) ( 38 )   Save
    BACKGROUND: The combination of machine learning and medical metal materials can make up for the inefficiency and high cost of traditional experiments and computational simulations, and quickly and accurately predict the characteristics of metal materials by analyzing large amounts of data, optimize material design and performance, and improve the safety and efficiency of medical applications.
    OBJECTIVE: To summarize the research progress and shortcomings of machine learning in the characteristics of medical materials. 
    METHODS: The first author searched CNKI, PubMed, X-MOL, and Web of Science databases by computer to search all relevant articles from January 2013 to April 2023. The Chinese search terms were “machine learning of medical metal materials, medical titanium alloy, medical magnesium alloy, medical metal material properties”. The English search terms were “machine learning medical metal materials, medical stainless steel alloy, medical cobalt-chromium alloy, medical titanium alloy, medical magnesium alloy”. Finally, 70 relevant articles were included for a summary.
    RESULTS AND CONCLUSION: (1) The introduction of machine learning as a material design methodology has opened up new paradigms for material science research as the accessibility of large amounts of data generated by traditional experimental and computational simulation methods increases. (2) The machine learning workflow is divided into four main parts: data collection and preprocessing, feature engineering, model selection and training, and model evaluation, each of which is indispensable. (3) Medical metal materials are categorized into: stainless steel co-base alloys, cobalt-chromium alloys, titanium alloys, and magnesium alloys. For stainless steel co-base alloy, machine learning predicts its mechanical properties, to improve the generalization ability of machine learning. For cobalt-chromium alloy, machine learning predicts its mechanical properties, and it can conclude that cobalt-chromium alloy is the optimal material for hip implants. For titanium alloy, machine learning predicts its mechanical properties, and it can select the implant with the best mechanical properties. For magnesium alloy, machine learning predicts its corrosion resistance and mechanical properties; the ensemble model can accurately predict the mechanical properties of magnesium alloys, and the random forest model can predict the optimal elemental contents of magnesium alloys as vascular stents. (4) Machine learning has deficiencies in the field of medical materials. For example, the model is relatively lagging; the data failed to be standardized, and the generalization is low. To solve such problems, we should make full use of deep learning and segmentation algorithm technology, use unified standard data, and improve the model to increase the generalization ability.
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    Research and advance of hydrogel-promoted endometrial repair in intrauterine adhesions
    Wu Haoming, Wang Yao, Chen Yuanmeng, Zhu Huili, Li Kainan, Xiong Chengdong, Hu Xulin
    2024, 28 (17):  2774-2781.  doi: 10.12307/2024.366
    Abstract ( 223 )   PDF (1208KB) ( 58 )   Save
    BACKGROUND: The key to preventing the recurrence of intrauterine adhesions is to reconstruct the endometrium with normal function. The latest breakthrough in the treatment of recurrent intrauterine adhesions in and outside China is the use of degradable materials to prepare hydrogels to prevent the recurrence of adhesions.
    OBJECTIVE: To review the research advance in hydrogel-promoted endometrial repair in intrauterine adhesions.
    METHODS: PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases were searched systematically, with the keywords “intrauterine adhesions, endometrial injury, endometrium regeneration, hydrogel” in Chinese and English. Relevant articles published in each database from January 1990 to March 2023 were collected.
    RESULTS AND CONCLUSION: In recent years, research on hydrogel-promoted endometrial repair in uterine adhesions in and outside China has made some progress and plays an important role in the prevention and treatment of intrauterine adhesions and the promotion of endometrial repair: (1) As an important carrier in tissue engineering, hydrogel itself has excellent biocompatibility, biodegradability and three-dimensional network structure, which can be better applied in the treatment of intrauterine adhesions. (2) The hydrogel-based carrier system can promote the proliferation and differentiation of endometrial epithelial cells by transporting drugs/biologics/stem cells, and restore normal uterine morphology to prevent adhesion recurrence. (3) Hyaluronic acid hydrogels can not only meet good biocompatibility, but also promote the proliferation and differentiation of endometrial epithelial cells, and will be hydrolyzed by corresponding enzymes in utero, without affecting the normal metabolism of the body. They are currently commonly used uterine anti-adhesion agents in the clinic and are also the most commonly used hydrogel carriers in tissue engineering research. (4) Poloxamer hydrogel with excellent temperature-sensitive properties can rapidly gelate into the body, quickly form a physical barrier, and can play a slow-release effect on carrying substances and provide a platform for cell growth/adhesion. (5) There are broad prospects for the preparation of therapeutic hydrogels using materials with different characteristics, such as temperature-sensitive hydrogels, pH-responsive hydrogels and photosensitive hydrogels, but there are still many problems to be solved, such as the safety of the hydrogel system, whether the degradation products cause immune reactions, and whether they have an impact on the normal body’s menstrual period. A large number of animal experiments and clinical trials are needed to verify its safety and efficacy, and continuously improve the treatment strategy.
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    Clinical application of additive manufacturing technology
    Cheng Weilu, Liu Yinghui
    2024, 28 (17):  2782-2788.  doi: 10.12307/2024.447
    Abstract ( 222 )   PDF (866KB) ( 28 )   Save
    BACKGROUND: Additive manufacturing technology provides strong technical support for personalized and precise medical treatment due to its rapid prototyping, digitalization, and personalization. Therefore, its medical devices have developed rapidly in orthopedics, oral, preoperative planning, craniomaxillofacial, and other clinical applications.
    OBJECTIVE: To briefly introduce the progress of additive manufacturing technology and its commercial application in the clinic in and outside China. 
    METHODS: Wanfang Data, China National Knowledge Infrastructure (CNKI), PubMed, Elsevier, Springer Link databases, and the websites of National Medical Products Administration and FDA were searched using “additive manufacturing, medical device, clinical application, 3D printing” as Chinese search terms and “additive manufacturing (AM), additive manufacturing technology, medical device, clinical application, 3D printing” as English search terms. The search time ranged from January 2010 to March 2023, and a few classical long-term articles were included. 
    RESULTS AND CONCLUSION: Additive manufacturing technology is classified by the form of raw materials (liquid-based, solid-based, and powder-based). At present, there are seven kinds of additive manufacturing processes, including fused deposition molding, stereo-curing molding, powder bed melting, directed energy deposition, binder jet 3D printing, inkjet printing, and layered solid manufacturing. The marketed additive manufacturing products include orthopedic products, dental products, preoperative planning guide plate/bone model products, and craniomaxillofacial products. The orthopedic products include matching long-segment bone defect restoration, interbody fusion cage, knee joint orthosis, vertebral prosthesis, thoracolumbar fusion matching prosthesis system, knee prosthesis, and hip prosthesis. Dental products include light-curing resin for additive manufacturing and BB Base 3D Printing Resin for Denture Base. The products of preoperative planning guide plates/bone models include bone models, medical orthopedic surgical guide plates, customized dental implant guide plates, and human organ models. The craniomaxillofacial products include polycaprolactone scaffolds, patient-specific skull implants, OsteoFab patient-specific face device, SpinFab VBR prosthesis, and TruMatch CMF titanium alloy 3D printing prosthesis system. 
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