Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis

There are quite a few controversies on surgical management of single-segment thoracic spinal tuberculosis (STB) with neurological deficits. The present study was to compare single-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of single-segment thoracic STB with neurological deficits and to determinethe clinical feasibility and effectiveness of posterior-only surgical treatment. Sixty patients with single-segment thoracic STB with neurological deficits were treated with one of two surgical procedures in our center from January 2003 to January 2013. Thirty patients were treated with posterior-only surgery (Group A) andthirty were treated with combined posterior-anterior surgery (Group B). The American Spinal Injury Association (ASIA) score system to evaluate the neurological deficits, thevisual analogue scale (VAS) to assess the degree of pain, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to judge the activity of tuberculosis (TB), surgery duration, intraoperative blood loss, length of hospitalization, bonyfusion rates, and kyphosis correction of the two groups were compared. The average follow-up period was 36.5 ± 9.2 months for Group A and 34.6 ± 10.2 months for Group B. Under the ASIA score system, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in allpatients. There were no persistent or recurrent infections orobvious differences in radiological results between thegroups. The kyphosis deformity was significantly corrected after surgical management. The average operative duration, blood loss, length of hospital stay, and postoperative complication rateof Group A were lower than those of Group B. In conclusions, posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.     

Biocompatible polymer implants in pediatric orthopedics

Priorov Central Scientific-Research Institute for Traumatology and Orthopedics, Moscow. Translated from Meditsinskaya Tekhnika, No. 4, pp. 47–48, July–August, 1994.     

Biocompatible implants for the sustained zero-order release of narcotic antagonists.

Implantable, sustained release drug delivery devices offer benefits not obtained through oral ingestion or injection. These include delivery at a constant therapeutic rate, thus avoiding adverse intermittent and massive dose effects, as well as reliance upon patients taking their prescribed dosages. The drawbacks to their widespread acceptance have been their inability to maintain a zero-order release rate over an extended period of time and poor biocompatibility. Devices capable of satisfying these requirements have been developed and tested extensively for in vitro release of the narcotic antagonist cyclazocine. By using implant models prepared from Hydron, a hydrophilic polymer known to exhibit excellent tissue compatibility, we have found that the release rate could be precisely regulated by proper geometry, copolymer composition, concentration of ionogenic groups and cross-link density. Devices in such varied forms as capusles, barrier-film coated tablets and bulk polymerized rods have been tested in vitro for periods approaching 1 year.     

Efficacy of ciprofloxacin implants in treating experimental osteomyelitis

Ciprofloxacin (CFX) implants containing poly(D,L-lactide) and calcium phosphates (tricalcium phosphate and hydroxyapatite) was evaluated in 50 rabbits in an experimental osteomyelitis model. Their femoral cavity was inoculated with Staphylococcus aureus. After 2 weeks, the infected focus was cleaned out and the delivery system implanted. The infection and subsequent response to treatment were evaluated by microbiological analysis, biochemical and hematological markers, body weight, temperature, clinical signs, X-rays, and histology. Infected bone cultures, treated with CFX implants, showed reduced bacterial growth against controls. All CFX was released within 6 weeks. All animals recovered within 4 weeks. Even 12 weeks after implantation, no recurrence of infection was observed. Serum C-reactive protein, platelet, and leukocyte levels increased in all animals before treatment, and 4 weeks after it were maintained or rose in control animals, while decreased to normal levels in treated ones. Body weight was characterized by pretreatment losses, then gains during recuperation, or further loss in untreated animals; with no significant intraindividual differences in body temperature. Body weight, leucocytes, platelets, and C-reactive protein turned out to be highly useful markers for monitoring this kind of infection and its treatment. CFX implants demonstrated to be an effective therapy for S. aureus bone infection. Their efficacy was also reflected in decreasing severity of clinical signs, nonprogress of radiological signs indicative of infection, and good integration into bone structure. Histological examination revealed repair, with new bone formation extending into implants.     

Biocompatible polymer composition for local antibacterial prophylaxis

Conclusions 1. Single application of Ambipor to wound tissue at the end of surgical operation maintains high concentration of antibiotics in paravulnar tissue over a long period. The concentration of the antibiotics is many times higher than in traditional antibacterial therapy. 2. Implantation of Ambipor into operative wound tissue at the end of the operation reduces microbial dissemination 100-1000-fold, improves regeneration, activates fibroblasts, stimulates fibrillogenesis, and facilitates cicatrization. 3. Local antibacterial therapy with Ambipor is an effective method for preventing postoperative wound complications. In clinics this reduced the frequency of complications more than 4.5-fold versus a control group of patients. Sklifosovskii Moscow Scientific-Research Institute for Energency Medical Care and All-Russian Scientific-Research and Testing Institute for Medical Instrument Engineering, Moscow. Translated from Meditsinskaya Tekhnika, No. 4, pp. 37–40, July–August, 1994.     

Biocompatible polymer materials for conservative uterine plastic surgery

Sechenov Moscow Medical Academy. Translated from Meditsinskaya Tekhnika, No. 3, pp. 40–41, May–June, 1994.     

Biocompatible hyperbranched polyester magnetic nanocarrier for stimuli-responsive drug release

A novel biocompatible magnetic nanocomposite drug carrier was developed by first chemically modifying a hyperbranched polyester (HBPE) with dodecenyl succinic anhydride (DDSA) functional groups to produce HBPE-DDSA. The magnetic nanocomposite Fe₃O₄/HBPE-DDSA was then synthesized by dispersing superparamagnetic iron oxide (Fe₃O₄) nanoparticles within HBPE-DDSA. The structure and magnetic properties of the nanocomposite were characterized by ¹H NMR, MALDI-MS, XRD, FTIR, TEM, and SQUID analyses. Isoniazid (INH) was selected as a model antituberculosis drug to investigate the in vitro drug release properties of Fe₃O₄/HBPE-DDSA/INH. The cytotoxicity of the magnetic nanocomposites was assessed by CCK-8 assay. The results indicated that Fe₃O₄/HBPE-DDSA is a promising potential drug carrier for a magnetic-targeted drug delivery system.     

依那西普和传统合成改变病情抗风湿药序贯治疗轻中度强直性脊柱炎的中期疗效随访研究

目的 随访评估依那西普和传统合成改变病情抗风湿药（conventional synthetic disease modifying anti-rheumatic drugs,csDMARDs）序贯治疗强直性脊柱炎（ankylosing spondylitis,AS）的药物组合方案治疗轻中度AS的中期疗效。方法 纳入南方医院2017～2018年确诊的轻中度AS患者64例,疾病活动期短期选用依那西普,疾病缓解期改用csDMARDs药物组合口服维持。分别于治疗前,治疗后3、6、12个月评估临床缓解率,并应用BASFI、BASDAI、SQOL-AS量表评价治疗效果。结果 随访3、6、12个月,Patient Global、BASFI、BASDAI及ASDAS-CRP评分,CRP及ESR值均下降（P<0.05）,SQOL-AS评分提高（P<0.05）。随访终点分别有85.9%、79.7%的患者达到ASAS 20、ASAS 40缓解标准。随访期间无结核、机会感染、肿瘤发生。结论 对于轻中度AS,依那西普和csDMARDs序贯组合方案展示了良好的中期疗效,有望成为低收入AS患者的替代治疗...     

Developments and Control of Biocompatible Conducting Polymer for Intracorporeal Continuum Robots

Dexterity of robots is highly required when it comes to integration for medical applications. Major efforts have been conducted to increase the dexterity at the distal parts of medical robots. This paper reports on developments toward integrating biocompatible conducting polymers (CP) into inherently dexterous concentric tube robot paradigm. In the form of tri-layer thin structures, CP micro-actuators produce high strains while requiring less than 1 V for actuation. Fabrication, characterization, and first integrations of such micro-actuators are presented. The integration is validated in a preliminary telescopic soft robot prototype with qualitative and quantitative performance assessment of accurate position control for trajectory tracking scenarios. Further, CP micro-actuators are integrated to a laser steering system in a closed-loop control scheme with displacements up to 5 mm. Our first developments aim toward intracorporeal medical robotics, with miniaturized actuators to be embedded into continuum robots.     

Biocompatible inkjet printing technique for designed seeding of individual living cells

Inkjet printers are capable of printing at high resolution by ejecting extremely small ink drops. Established printing technology will be able to seed living cells, at micrometer resolution, in arrangements similar to biological tissues. We describe the use of a biocompatible inkjet head and our investigation of the feasibility of microseeding with living cells. Living cells are easily damaged by heat; therefore, we used an electrostatically driven inkjet system that was able to eject ink without generating significant heat. Bovine vascular endothelial cells were prepared and suspended in culture medium, and the cell suspension was used as "ink" and ejected onto culture disks. Microscopic observation showed that the endothelial cells were situated in the ejected dots in the medium, and that the number of cells in each dot was dependent on the concentration of the cell suspension and ejection frequency chosen. After the ejected cells were incubated for a few hours, they adhered to the culture disks. Using our non-heat-generating, electrostatically driven inkjet system, living cells were safely ejected onto culture disks. This microseeding technique with living cells has the potential to advance the field of tissue engineering.     

Biocompatible nanofiber matrices for the engineering of a dermal substitute for skin regeneration

Natural and synthetic biodegradable nanofibers are extensively used for biomedical applications and tissue engineering. Biocompatibility and a well-established safety profile for polycaprolactone (PCL) and collagen represent a favorable matrix for preparing a dermal substitute for engineering skin. Collagen synthesized by fibroblasts is a good surface active agent and demonstrates its ability to penetrate a lipid-free interface. During granulation tissue formation, fibronectin provides a temporary substratum for migration and proliferation of cells and provides a template for collagen deposition, which increases stiffness and tensile strength of this healing tissues. The objective of this study was to fabricate nanofiber matrices from novel biodegradable PCL and collagen to mimic natural extracellular matrix (ECM) and to examine the cell behavior, cell attachment, and interaction between cells and nanofiber matrices. Collagen nanofiber matrices show a significant (p < 0.001) level of fibroblast proliferation and increase up to 54% compared with control tissue culture plate (TCP) after 72 h. The present investigation shows that PCL-coated collagen matrices are suitable for fibroblast growth, proliferation, and migration inside the matrices. This novel biodegradable PCL and collagen nanofiber matrices support the attachment and proliferation of human dermal fibroblasts and might have potential in tissue engineering as a dermal substitute for skin regeneration.     

Ixekizumab for the treatment of ankylosing spondylitis

ABSTRACT

Introduction

Ixekizumab (IXE) is a high affinity IgG4 approved for the treatment of ankylosing spondylitis (AS). Recently, two phase III randomized clinical trials (COAST-V, COAST-W) showed significant and sustained improvements in signs and symptoms of AS as evaluated by ASAS40 response. Areas covered: The authors performed a comprehensive literature search on this topic, by a review of published articles to date. The authors introduced the structure and the mechanism of action of IXE, and critically reviewed data from clinical trials, concerning its efficacy and safety in AS.Expert opinion: IXE proved dramatic efficacy and tolerable safety in patients with AS, in particular, patients with intolerance or insufficient response to TNFi, which provides an alternative and breakthrough for the treatment options of AS. IXE might not work in AS with IBD and uveitis involvement. Patients treated with IXE should be aware of candida infection in long term application.     

Biocompatible, smooth, plasma-treated nickel-titanium surface--an adequate platform for cell growth

High nickel content is believed to reduce the number of biomedical applications of nickel-titanium alloy due to the reported toxicity of nickel. The reduction in nickel release and minimized exposure of the cell to nickel can optimize the biocompatibility of the alloy and increase its use in the application where its shape memory effects and pseudoelasticity are particularly useful, e.g., spinal implants. Many treatments have been tried to improve the biocompatibility of Ni-Ti, and results suggest that a native, smooth surface could provide sufficient tolerance, biologically. We hypothesized that the native surface of nickel-titanium supports cell differentiation and insures good biocompatibility. Three types of surface modifications were investigated: thermal oxidation, alkali treatment, and plasma sputtering, and compared with smooth, ground surface. Thermal oxidation caused a drop in surface nickel content, while negligible chemistry changes were observed for plasma-modified samples when compared with control ground samples. In contrast, alkali treatment caused significant increase in surface nickel concentration and accelerated nickel release. Nickel release was also accelerated in thermally oxidized samples at 600 °C, while in other samples it remained at low level. Both thermal oxidation and alkali treatment increased the roughness of the surface, but mean roughness R(a) was significantly greater for the alkali-treated ones. Ground and plasma-modified samples had 'smooth' surfaces with R(a)=4 nm. Deformability tests showed that the adhesion of the surface layers on samples oxidized at 600 °C and alkali treatment samples was not sufficient; the layer delaminated upon deformation. It was observed that the cell cytoskeletons on the samples with a high nickel content or release were less developed, suggesting some negative effects of nickel on cell growth. These effects were observed primarily during initial cell contact with the surface. The most favorable cell responses were observed for ground and plasma-sputtered surfaces. These studies indicated that smooth, plasma-modified surfaces provide sufficient properties for cells to grow.     

强直性脊柱炎生物制剂治疗的进展

近年来国内外在风湿免疫性疾病的生物制剂治疗的基础与临床方面已展开了广泛的研究和讨论。生物制剂作为最新的有效治疗策略使该类疾病治疗方法发生了巨大的变化,水平得到了极大提高。强直性脊柱炎(ankylosing spondylitis,AS)是一种以累及脊柱和骶髂关节为特征的系统性炎性、病情多难以控制、部分患者可致残的常见风湿免疫性疾病之一。临床上,我们希望能及早地抑制炎症而使AS得到缓解,但多年来AS的治疗并没有令人信服的好方法,目前尚存在许多误诊误治,使多数患者丧失信心。为此,我们急切需要提高对AS治疗概况的新认识,掌握AS早期诊断及…     

单节段经椎弓根椎体截骨术治疗强直性脊柱炎

目的总结单节段经椎弓根椎体截骨术治疗强直性脊柱后凸畸形的临床疗效。方法 2005~2010采取单节段经椎弓根椎体截骨术治疗20例强直性脊柱炎后凸畸形患者。术前、术后均行胸腰椎X线检查,评定胸腰段Cobb角矫正情况、植骨愈合情况、临床疗效、内固定位置及手术并发症。结果无术中死亡及术后感染,术中2例患者硬膜破裂,术后1例患者麻痹性肠梗阻,2例出现短暂不全瘫。随访15~60个月,后凸畸形均获明显矫正,胸腰段Cobb角平均矫正35.6°,矫正前后有显著性差异﹙<0.05﹚。末次随访无内固定断裂、脱出,均达骨性融合。结论单节段经椎弓根椎体截骨术治疗强直性脊柱脊柱后凸畸形,矫形效果及临床疗效满意。     

Intraoperative dynamic dosimetry for prostate implants

This paper describes analytic tools in support of a paradigm shift in brachytherapy treatment planning for prostate cancer--a shift from standard pre-planning to intraoperative planning using dosimetric feedback based on the actual deposited seed positions within the prostate. The method proposed is guided by several desiderata: (a) bringing both planning and evaluation in the operating room (i.e. make post-implant evaluation superfluous) therefore making rectifications--if necessary--still achievable; (b) making planning and implant evaluation consistent by using the same imaging system (ultrasound); and (c) using only equipment commonly found in a hospital operating room. The intraoperative dosimetric evaluation is based on the fusion between ultrasound images and 3D seed coordinates reconstructed from fluoroscopic projections. Automatic seed detection and registration of the fluoroscopic and ultrasound information, two of the three key ingredients needed for the intraoperative dynamic dosimetry optimization (IDDO), are explained in detail. The third one, the reconstruction of 3D coordinates from projections, was reported in a previous article. The algorithms were validated using a custom-designed phantom with non-radioactive (dummy) seeds. Also, fluoroscopic images were taken at the conclusion of an actual permanent prostate implant and compared with data on the same patient obtained from radiographic-based post-implant evaluation. To offset the effect of organ motion the comparison was performed in terms of the proximity function of the two seed distributions. The agreement between the intra- and post-operative seed distributions was excellent.