椎体成形术中注射聚甲基丙烯酸酯和锶羟磷灰石的比较

【目的】比较采用两种填充物聚甲基丙烯酸酯(polymethylmethacrylate,PMMA)和锶羟磷灰石(strontium-contained hydroxyapatitecement,SrHAC)行经皮椎体成形术(percutaneous vertebroplasty,PVP)的临床应用结果。【方法】选择单椎体骨折患者49例,其中男19例,女30例,随机分成2组,PMMA组26例,SrHAC组23例,对填充物注入量、术中患者血压、心率、血氧饱和度及术后填充物渗漏、疼痛改善、临床效果、影像学征象等指标进行评价分析。【结果】PMMA组平均注入量为(2.82±0.39)mL,SrHAC组平均注入量为(3.75±0.52)mL,两组比较差异有统计学意义(P<0.01)。SrHAC组注入填充物时血压、心率、血氧饱和度稳定。PMMA组视觉模拟量表(visual analogue pain scale,VAS)评分由术前平均的(7.0±0.8)分下降至末次随访时的(1.7±0.4)分;SrHAC组术前平均为(7.2±1.0)分,末次随访降为(1.8±0.5)分。两组组内比较手术前后差异均有统计学意义(P<0.01)。术后临床效果SC法评价,优良率:PMMA组为84.6%、SrHAC组为82.6%,两组比较差异无统计学意义(P>0.05)。末次随访时椎体均无继续塌陷征象。随访达1年以上的SrHAC组见填充物开始降解。【结论】应用两种填充剂行PVP均为治疗骨质疏松性椎体压缩性骨折的有效办法。     

五倍子水提取物对人牙周膜细胞保护作用的实验研究

目的:观察五倍子水提取物对内毒素(LPS)所致人牙周膜细胞(PDLC)活性降低、超微结构损伤、在牙骨质片表面附着减少、以及碱性磷酸酶(ALP)活性降低的影响,探讨五倍子水提取物对PDLC的保护作用.方法:采用细胞培养技术、3H-TdR掺入法、细胞计数法、透射与扫描电子显微镜技术、酶联免疫技术观察五倍子水提取物对PDLC的保护作用.结果:培养液中加入100μg/mL LPS时,PDLC活性和ALP活性受到明显抑制,超微结构损伤,细胞在牙骨质片表面附着减少.加入五倍子水提取物溶液后,对LPS抑制PDLC活性和ALP活性,以及超微结构损伤、牙骨质片表面附着减少有拮抗作用,该作用随五倍子水提取物浓度增加而增加,到10μg/mL时,达到峰值.结论:五倍子水提取物对PDLC具有保护作用,有望成为防治牙周病的药物.     

Novel factor-loaded polyphosphazene matrices: Potential for driving angiogenesis

Currently employed bone tissue engineered scaffolds often lack the potential for vascularization, which may be enhanced through the incorporation of and regulated release of angiogenic factors. For this reason, the objective here was to fabricate and characterize protein-loaded amino acid ester polyphosphazene (Pphos)-based scaffolds and evaluate the novel sintering method used for protein incorporation, a method which will ultimately allow for the incorporation of proangiogenic agents. To test the hypothesis, Pphos and their composite microspheres with nanocrystalline hydroxyapatite (Pphos-HAp) were fabricated via the emulsion solvent evaporation method. Next, bovine serum albumin (BSA)-containing microsphere matrices were created using a novel solvent–non-solvent approach for protein loading. The resulting protein (BSA) loaded circular porous microsphere based scaffolds were characterized for morphology, porosity, protein structure, protein distribution and subsequent protein release pattern. Scanning electron microscopy revealed porous microsphere scaffolds with a smooth surface and sufficient level of sintering, illustrated by fusion of adjacent microspheres. The porosity measured for the poly(ethyl phenylalanato:glycinato)phosphazene (PNPhGly) and poly(ethyl phenylalanato:glycinato)phosphazene-hydroxyapatite (PNPhGly-HAp) scaffolds were 23 ± 0.11% and 18 ± 4.02%, respectively, and within the range of trabecular bone. Circular dichroism confirmed an intact secondary protein structure for BSA following the solvent sintering method used for loading and confocal microscopy verified that FITC-BSA was successfully entrapped both between adjacent microspheres and within the surface of the microspheres while sintering. For both Pphos and their composite microsphere scaffolds, BSA was released at a steady rate over a 21 day time period, following a zero order release profile. HAp particles in the composite scaffolds served to improve the release profile pattern, underscoring the potential of HAp for growth factor delivery. Moreover, the results of this work suggest that the solvent–non-solvent technique for protein loading is an optimal one that will allow for future development of angiogenic factor-loaded Pphos matrices with the capacity to invoke neovascularization.     

A modified glass ionomer cement to mediate dentine repair

ObjectivesGlass ionomer cements (GIC) can be used to protect dentine following caries removal. However, GIC have little biological activity on biological repair processes, which means that neo-dentine formation remains reliant on limited endogenous regenerative processes. Wnt/β-catenin signalling is known to play a central role in stimulating tertiary dentine formation following tooth damage and can be stimulated by a range of glycogen synthase kinase (GSK3) antagonists, including lithium ions.MethodsHere, we created lithium-containing bioactive glass (BG) by substituting lithium for sodium ions in 45S5 BG. We then replaced between 10 and 40% of the powder phase of a commercial GIC with the lithium-substituted BG to create a range of formulations of ‘LithGlassGIC’. In vitro physical properties of the resulting glasses were characterised and their ability to stimulate reactionary dentine formation in mouse molars in vivo was tested.ResultsLithium release from LithGlassGIC increased with increasing lithium content in the cement. In common with unmodified commercial GIC, all formations of LithGlassGIC showed in vitro toxicity when measured using an indirect cell culture assay based on ISO10993:5, precluding direct pulp contact. However, in a murine non-exposed pulp model of tooth damage, LithGlassGIC quickly released lithium ions, which could be transiently detected in the saliva and blood. LithGlassGIC also enhanced the formation of tertiary dentine, resulting in a thickening of the dentine at the damage site that restored lost dentine volume. Dentine regeneration was likely mediated by upregulation of Wnt/β-catenin activity, as LithGlassGIC placed in TCF/Lef:H2B-GFP reporter mice showed enhanced GFP activity.SignificanceWe conclude that LithGlassGIC acts as a biological restorative material that promotes tertiary dentine formation and restores tooth structure.     

Anaesthesia for joint replacement surgery

Joint replacement surgery, especially hip and knee, demand is increasing globally. Many patients are elderly, frail and have significant comorbidity requiring careful perioperative management. Patient prehabilitation and enhanced recovery protocols have been successfully introduced. Multimodal analgesia including regional nerve blocks, deep venous thromboembolism prophylaxis, blood management and bone cement implantation syndrome are some important perioperative aspects to be considered.     

Functionalization of Polycaprolactone Electrospun Osteoplastic Scaffolds with Fluorapatite and Hydroxyapatite Nanoparticles: Biocompatibility Comparison of Human Versus Mouse Mesenchymal Stem Cells

A capability for effective tissue reparation is a living requirement for all multicellular organisms. Bone exits as a precisely orchestrated balance of bioactivities of bone forming osteoblasts and bone resorbing osteoclasts. The main feature of osteoblasts is their capability to produce massive extracellular matrix enriched with calcium phosphate minerals. Hydroxyapatite and its composites represent the most common form of bone mineral providing mechanical strength and significant osteoinductive properties. Herein, hydroxyapatite and fluorapatite functionalized composite scaffolds based on electrospun polycaprolactone have been successfully fabricated. Physicochemical properties, biocompatibility and osteoinductivity of generated matrices have been validated. Both the hydroxyapatite and fluorapatite containing polycaprolactone composite scaffolds demonstrated good biocompatibility towards mesenchymal stem cells. Moreover, the presence of both hydroxyapatite and fluorapatite nanoparticles increased scaffolds’ wettability. Furthermore, incorporation of fluorapatite nanoparticles enhanced the ability of the composite scaffolds to interact and support the mesenchymal stem cells attachment to their surfaces as compared to hydroxyapatite enriched composite scaffolds. The study of osteoinductive properties showed the capacity of fluorapatite and hydroxyapatite containing composite scaffolds to potentiate the stimulation of early stages of mesenchymal stem cells’ osteoblast differentiation. Therefore, polycaprolactone based composite scaffolds functionalized with fluorapatite nanoparticles generates a promising platform for future bone tissue engineering applications.