Effect of totally absorbable implant volume on wound infection rate: Study of 2500 operated fractures, osteotomies, and ligament injuries

Between November 1984 and January 1994 in our department, a total of 2500 patients were treated with totally absorbable internal fixation devices. We studied these patients and analyzed results with regard to the volume of the absorbable implants and the development of wound infection. Of the 2500 patients 2044 were trauma patients and 456 were operated on for orthopedic disease. In 1466 patients treated with implants made of self-reinforced polyglycolic acid (SR-PGA) only, the patients who developed wound infection had a higher implant volume (P=0.07) than those who did not; this difference was close to statistical significance. In the 446 patients who received only implants made of self-reinforced poly-l-lactic acid (SR-PLLA), the 5 who developed wound infection had a mean implant volume more than three times that of the non-infected patients (P=0.01). We found that in the patients treated with the earlier SR-PGA implants, which contained a green staining material, there was no correlation between implant volume and incidence of wound infections. On the other hand, both the non-stained SR-PGA implants, which have been in clinical use since 1989, and the SR-PLLA implants, seem to be more predictable in terms of wound infections. We believe that this difference, is largely due to the lower level of tissue reactions with these newer implants.     

异种脱细胞角膜基质囊袋移植的生物相容性研究

目的探讨脱细胞猪角膜基质移植入兔角膜囊袋后的生物学反应。方法猪角膜通过不同方式去除细胞及免疫源性成分，保留角膜组织基质的弹力纤维及胶原纤维，将其切取为直径为4mm的植片，植入兔角膜囊袋内，在不同时间点观察生物材料在角膜内生物学反应。结果材料植入兔角膜囊袋3个月，生物相容性良好，材料逐渐降解，材料内有胶原和角膜基质细胞长人。结论新型可降解角膜基质材料植入后未见兔角膜有明显的炎症反应，材料的组织相容性好，可作为组织工程角膜的支架材料。     

再生柞蚕丝素蛋白对人骨髓间充质干细胞体外扩增的支持作用

大量的研究表明家蚕丝素蛋白具有良好的生物相容性。而对于柞蚕丝素蛋白在医用生物领域的研究报道在国内外尚较少。本研究选择再生柞蚕丝素蛋白为研究对象，观察了人骨髓间充质干细胞（hBMSCs）在再生柞蚕丝素膜上的粘附、生长及表面抗原的变化。结果在1h观察再生柞蚕丝素对hBMSCs的粘附力几乎与胶原相同，明显优于家蚕丝素和聚苯乙烯培养板。MTT法检测结果显示在第4d hBMSCs在再生柞蚕丝素膜上的增殖明显高于其他各组。电镜观察结果显示hBMSCs在再生柞蚕丝素膜上能够很好的粘附、生长，细胞间能相互连接形成片状结构。流式细胞仪检测再生柞蚕丝素蛋白对hBMSCs表面抗原的表达亦无明显影响。本研究结果显示再生柞蚕丝素蛋白体外支持hBMSCs的粘附、生长，具有良好的细胞相容性。     

Modulation of Staphylococcus aureus adhesion by biofunctional copolymers derived from polystyrene

Biomaterials-centered infections are serious complications associated with the use of implants. The infection risk of biomaterials varies between different materials and is determined by the chemical composition of materials, the host proteins and the type of bacteria. In this study we measured the initial adhesion of Staphylococcus aureus onto polystyrene derivatives containing carboxylate and sulfonate groups. Five polymers were synthesized and characterized. We studied the role of the host protein fibronectin in promoting adhesion of Staphylococcus aureus. Fibronectin adsorption was comparable on all the tested polymers (pKd=7.2±0.2) whereas bacterial adhesion was dependent on surfaces chemical compositions. Polymers substituted with sulfonate groups showed the most important inhibition of initial bacterial adhesion.     

Degradable poly(anhydride ester) implants: effects of localized salicylic acid release on bone

Degradable poly(anhydride ester) implants in which the polymer backbone breaks down into salicylic acid (SA) were investigated. In this preliminary work, local release of SA from the poly(anhydride esters), thus classified as ‘active polymers', on healthy bone and tissue was evaluated in vivo using a mouse model. Degradable polyanhydrides that break down into inactive by-products were used as control membranes because of their chemical similarity to the active polymers. Small polymer squares were inserted over the exposed palatal bone adjacent to the maxillary first molars. Active polymer membranes were placed on one side of the mouth, control polymers placed on the contra lateral side. Intraoral clinical examination showed that active polymer sites were less swollen and inflamed than control polymer sites. Histopathological examination at day 1 showed essentially no difference between control and active polymers. After 4 days, active polymer sites showed epithelial proliferation to a greater extent than the polyanhydride controls. After 20 days, active polymer sites showed greater thickness of new palatal bone and no resorptive areas, while control polymer sites showed less bone thickness as well as resorption including lacunae involving cementum and dentine. From these preliminary studies, we conclude that active polymers, namely poly(anhydride esters), stimulated new bone formation.     

Biological resurfacing of the knee: a review of surgical management

Lesions of the articular surfaces of the knee have been managed by various techniques over the last 50 years. Surgical management has involved: excising the damaged area, refashioning the underlying bone to produce a fibrous response, and introducing allograft, autograft and synthetic materials to encourage a repair matrix. The techniques and their pitfalls are reviewed and discussed, and suggestions made as to the direction of future studies for the repair of osteochondral lesions in the painful knee.     

Comparison of the Biological Behavior and Topographical Surface Assessment of a Minimally Invasive Dental Implant and a Standard Implant: An In Vitro Study

The current study aimed to assess the topographical and physical properties of a minimally invasive implant (MagiCore^®: MC^®, InnosBioSurg, IBS) and to evaluate its biological behavior compared to a gold standard implant (NobelParallel™: NB™, Nobel Biocare™). After surface characterization, the biological behavior assessment was conducted regarding human gingival fibroblasts (hGF) and osteoblast-like cells (MG63). Roughness values for NB^TM were Ra = 1.28 µm and for MC^® they were Ra = 2.02 µm. Alamar Blue^TM assay LIVE/DEAD^TM staining results indicated equivalent biological development regarding both cell types for the two implants. Significant enhancement was found for hGF ALP activity in the presence of the two tested implants in a time-dependent manner from day 7 to day 14 (** p < 0.01). Alizarin red staining demonstrated significant calcium deposition enhancement when cells were interfaced with the NB™ compared to the MC^® implant (** p < 0.05). Moreover, SEM and confocal imaging revealed good cell adhesion with a denser cellular layer on the MC^® than the NB™ surface. The MC^® cytocompatibility was ranked as equivalent to the gold standard implant despite the surface properties differences. These findings provide new insights about the minimally invasive implant’s biological behavior and its potential clinical implication in different implantology situations.     

Development and Characterization of PBSA-Based Green Composites in 3D-Printing by Fused Deposition Modelling

Fused deposition modelling is a rapidly growing additive manufacturing technology due to its ability to build functional parts with complex geometries. The mechanical properties of a built part depend on several process parameters. The effect of wood content on the properties of 3D printed parts has been studied. Four types of filaments using poly(butylene succinate-co-adipate) (PBSA) with different reinforcement levels of Typha stem powder 0%, 5%, 10%, and 15% by weight were used for 3D printing. The density of the filaments and parts printed in this study increased with the Typha stem powder content. The thermal stability, mechanical performance, and viscoelastic properties of the different biocomposite filaments and 3D printed objects were analysed. The results show an increase in the crystallisation kinetics and a slight decrease in the thermal stability of the biomaterials. Compared to virgin PBSA FDM filaments, the PBSA biocomposite filament filled with Typha stem powder showed an increase in the tensile strength of the parts and specimens from 2.5 MPa to 8 MPa and in the modulus of elasticity from 160 MPa to 375 MPa, respectively, with additions of 5%, 10%, and 15% by mass. The addition of Typha stem fibres generated an increase in the elastic behaviour and relaxation time of the biomaterial structure, visualised by increases in the values of the viscosity components. The surface morphology reveals a decrease in the porosity of the printed samples.     

Preclinical evaluation of injectable bone substitute materials

Injectable bone substitutes (IBSs) represent an attractive class of ready‐to‐use biomaterials, both ceramic‐ and polymer‐based, as they offer the potential benefit of minimally invasive surgery and optimal defect filling. Although in vitro assessments are the first step in the process of development, the safety and efficacy of an IBS strongly depend on validated preclinical research prior to clinical trials. However, the selection of a suitable preclinical model for performance evaluation of an IBS remains a challenge, as no gold standard exists to define the best animal model. In order to succeed in this attempt, we identified three stages of development, including (a) proof‐of‐principle, (b) predictive validity and (c) general scientific legitimacy, and the respective criteria that should be applied for such selection. The second part of this review provides an overview of commonly used animals for IBSs. Specifically, scientific papers published between January 1996 and March 2012 were retrieved that report the use of preclinical models for the evaluation of IBSs in situations requiring bone healing and bone augmentation. This review is meant not only to describe the currently available preclinical models for IBS application, but also to address critical considerations of such multi‐factorial evaluation models (including animal species, strain, age, anatomical site, defect size and type of bone), which can be indicative but in most cases edge away from the human reality. Consequently, the ultimate goal is to guide researchers toward a more careful and meaningful interpretation of the results of experiments using animal models and their clinical applications. Copyright © 2012 John Wiley & Sons, Ltd.