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Corduneanu‑Luca A, Pasca S, Tamas C, Moraru D, Ciuntu B, Stanescu C, Hreniuc‑Jemnoschi I, Tecuceanu A, Stamate T. Improving flexor tendon gliding by using the combination of carboxymethylcellulose‑polyethylene oxide on murine model. Exp Ther Med 2021; 23:105. [PMID: 34976147 PMCID: PMC8674966 DOI: 10.3892/etm.2021.11028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022] Open
Abstract
The current approach to flexor tendon injuries is complex and is no longer limited to suturing techniques. Strategies for improving hand function currently include rehabilitation protocols, appropriate suturing materials and techniques, changing the gliding surface by using lubricants and providing growth factors. One product, originally used in spinal surgery, has been shown to be effective in preventing postoperative adhesions. It is a combination of carboxymethylcellulose and polyethylene oxide-Dynavisc® (FzioMed, Inc.). The aim of the present study was to test the effect of Dynavisc® on acute injuries of the intrasynovial flexor tendons in the prevention of postoperative adhesions and the improvement of functional results. The study was performed on 20 Wistar rats distributed in two groups. The control group, represented by 10 rats, in which after the reconstruction of the flexor tendon, the peritendinous area was injected with saline solution and the study group, in which the peritendinous area was injected with a single administration of the lubricating gel, Dynavisc® (carboxymethylcellulose and polyethylene oxide). At 4 and 12 weeks, the rats were sacrificed and tissue biopsy consisted of tendon fragments and adjacent tissue. The evaluation of the results was performed by measuring the adhesion score and observing histological parameters. The presence of important adhesions was found in the control group compared with the group treated with Dynavisc®, where a supple and smooth tendon, with significantly fewer adhesions were found. The differences between the two groups were significant, thus indicating the efficiency of the lubricant in preventing adhesions. This study supported the important role of Dynavisc® in the regeneration of the tendon and the peritendinous structures, by limiting aberrant fibrous proliferation in the regeneration process and helping to build a peritendinous space.
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Affiliation(s)
| | - Sorin Pasca
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, ‘Ion Ionescu de la Brad’ University of Agricultural Sciences and Veterinary Medicine, 700490 Iasi, Romania
| | - Camelia Tamas
- Department of Plastic Surgery, Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dan Moraru
- Department of Plastic Surgery, Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Bogdan Ciuntu
- Department of General Surgery, Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Stanescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania
| | - Irina Hreniuc‑Jemnoschi
- Department of Plastic Surgery, Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Angela Tecuceanu
- Department of Plastic Surgery, Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Teodor Stamate
- Department of Plastic Surgery, Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
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Effect of Collagen Nerve Wrapping in a Rabbit Peripheral Neuropathy Model. Plast Reconstr Surg Glob Open 2021; 9:e3919. [PMID: 35028256 PMCID: PMC8751765 DOI: 10.1097/gox.0000000000003919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
Background: Collagen nerve wraps (CNWs) theoretically allow for improved nerve gliding and decreased perineural scarring, and create a secluded environment to allow for nerve myelination and axonal healing. The goal of this study was to investigate the effect of CNWs on nerve gliding as assessed by pull-out strength and nerve changes in a rabbit model of peripheral neuropathy. Methods: Ten New Zealand rabbits were included. Sham surgery (control) was performed on left hindlimbs. To simulate compressive neuropathy, right sciatic nerves were freed of the mesoneurium, and the epineurium was sutured to the wound bed. Five rabbits were euthanized at 6 weeks [scarred nerve (SN); n = 5]. Neurolysis with CNW was performed in the remaining rabbits at 6 weeks (CNW; n = 5), which were euthanized at 22 weeks. Outcomes included peak pull-out force and histopathological markers of nerve recovery (axonal and Schwann cell counts). Results: The CNW group demonstrated significantly higher pull-out forces compared with the CNW sham control group (median: 4.40N versus 0.37N, P = 0.043) and a trend toward greater peak pull-out forces compared with the SN group (median: 4.40N versus 2.01N, P = 0.076). The CNW group had a significantly higher median Schwann cell density compared with the CNW control group (CNW: 1.30 × 10−3 cells/μm2 versus CNW control: 7.781 × 10−4 cells/μm2, P = 0.0431) and SN group (CNW: 1.30 × 10−3 cells/μm2 versus SN: 7.31 × 10−4 cells/μm2, P = 0.009). No significant difference in axonal density was observed between groups. Conclusion: Our findings suggest using a CNW does not improve nerve gliding, but may instead play a role in recruiting and/or supporting Schwann cells and their proliferation.
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Crosio A, Ronchi G, Fornasari BE, Odella S, Raimondo S, Tos P. Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring. J Clin Med 2021; 10:jcm10081613. [PMID: 33920209 PMCID: PMC8070420 DOI: 10.3390/jcm10081613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 01/09/2023] Open
Abstract
As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices.
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Affiliation(s)
- Alessandro Crosio
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Piazza Andrea Ferrari 1, 20122 Milano, Italy; (A.C.); (S.O.); (P.T.)
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (G.R.); (B.E.F.)
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (G.R.); (B.E.F.)
| | - Simonetta Odella
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Piazza Andrea Ferrari 1, 20122 Milano, Italy; (A.C.); (S.O.); (P.T.)
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (G.R.); (B.E.F.)
- Correspondence: ; Tel.: +39-011-670-5433
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Piazza Andrea Ferrari 1, 20122 Milano, Italy; (A.C.); (S.O.); (P.T.)
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Hachinota A, Tada K, Yamamoto D, Nakajima T, Nakada M, Tsuchiya H. Preventive Effect of Alginate Gel Formulation on Perineural Adhesion. J Hand Surg Asian Pac Vol 2020; 25:164-171. [PMID: 32312202 DOI: 10.1142/s2424835520500186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Perineural adhesion is a potential complication of manipulating peripheral nerves. Using a model of median nerve manipulation in the carpal tunnel, perineural adhesion preventive effects of an alginate gel formulation were examined. Methods: After exposing carpal tunnels of Japanese white rabbits and dissecting the median nerve, the gliding floor was excised as much as possible and the transverse carpal ligament was repaired to induce a perineural tissue reaction. Prior to wound closure, 0.5 ml of alginate gel formulation was administered into the right carpal tunnel (formulation group) and 0.5 ml of physiological saline was administered into the left carpal tunnel (control group). At 1, 2, 3, and 6 weeks after treatment, electrophysiological evaluation of thenar distal latency, macroscopic evaluation with adhesion score, and pathological evaluation of carpal tunnel cross sections were performed (N = 4-5 at each time point). Results: Although distal latency tended to be low in the formulation group, there was no significant difference between the groups according to electrophysiological evaluation. Macroscopic evaluation revealed that the adhesion score was always lower in the formulation group than in the control group; over the course of treatment, it remained unchanged in the formulation group, but peaked at 3 weeks after treatment in the control group. In pathological evaluation, neural perfusion peaked at 2-3 weeks after treatment in both groups; neural perfusion tended to be lower in the formulation group than in the control group. Conclusions: Results suggested that the peak tissue response associated with nerve dissection occurred 2-3 weeks after treatment and that the repair process started subsequently. The alginate gel formulation modified the surrounding environment of the nerve and promoted repair by acting as a physical barrier against perineural fibrosis. The preventive effect of alginate gel on perineural adhesion may improve treatment outcomes of constrictive neuropathy.
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Affiliation(s)
- Ai Hachinota
- Department of Orthpaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Kaoru Tada
- Department of Orthpaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Daiki Yamamoto
- Department of Orthpaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Tadahiro Nakajima
- Department of Orthpaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Mika Nakada
- Department of Orthpaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthpaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
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Yapici AK, Bayram Y, Akgun H, Gumus R, Zor F. The effect of in vivo created vascularized neurotube on peripheric nerve regeneration. Injury 2017; 48:1486-1491. [PMID: 28529011 DOI: 10.1016/j.injury.2017.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Creating vascularized nerve conduits for treatment of nerve gaps have been researched, however, these methods need microsurgical anastomosis thereby complicating the nerve repair process. Thus, the concept of vascularized nerve conduits has not popularized up till now. The aim of this study is to evaluate the effects of vascularized and non-vascularized biological conduits on peripheral nerve regeneration. MATERIAL AND METHODS Following ethical board approval, 15 Sprague-Dawley rats were used in the study. The rats were equally divided into three groups. In group I, a silicon rod was inserted next to the sciatic nerve of the rat and connective tissue generated around this rod was used as a vascularized biological conduit. In group II, a silicon rod was inserted into the dorsum of the rat and connective tissue generated around this rod was used as a non-vascularized biological conduit. In group III, autogenic nerve graft was used to repair the nerve gap. The contralateral sciatic nerve is used as a control in all rats. Macroscopic, electrophysiological and histomorphometric evaluations were performed to determine the nerve regeneration. RESULTS There was no statistically significant difference between groups, in terms of latency. However, the mean amplitude of group I was found to be higher than other groups. The difference between group I and II was statistically significant. Myelinated axonal counts in group I was significantly higher than groups II and III. CONCLUSION Our results showed that vascularized biological conduits provided better nerve regeneration when compared to autografts and non-vascularized biological conduits. Creation and application of vascularized conduits by using the technique described here is easy. Although this method is not an alternative to autogenic nerve grafts, our results are promising and encouraging for further studies.
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Affiliation(s)
- Abdul Kerim Yapici
- Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey.
| | - Yalcin Bayram
- Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey
| | - Hakan Akgun
- Gulhane Military Medical Academy, Dept. of Neurology, Ankara, Turkey
| | - Recep Gumus
- Gulhane Military Medical Academy, Dept. of Histology, Ankara, Turkey
| | - Fatih Zor
- Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey
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Lemke A, Penzenstadler C, Ferguson J, Lidinsky D, Hopf R, Bradl M, Redl H, Wolbank S, Hausner T. A novel experimental rat model of peripheral nerve scarring that reliably mimics post-surgical complications and recurring adhesions. Dis Model Mech 2017; 10:1015-1025. [PMID: 28550101 PMCID: PMC5560061 DOI: 10.1242/dmm.028852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/24/2017] [Indexed: 01/25/2023] Open
Abstract
Inflammation, fibrosis and perineural adhesions with the surrounding tissue are common pathological processes following nerve injury and surgical interventions on peripheral nerves in human patients. These features can reoccur following external neurolysis, currently the most common surgical treatment for peripheral nerve scarring, thus leading to renewed nerve function impairment and chronic pain. To enable a successful evaluation of new therapeutic approaches, it is crucial to use a reproducible animal model that mimics the main clinical symptoms occurring in human patients. However, a clinically relevant model combining both histological and functional alterations has not been published to date. We therefore developed a reliable rat model that exhibits the essential pathological processes of peripheral nerve scarring. In our study, we present a novel method for the induction of nerve scarring by applying glutaraldehyde-containing glue that is known to cause nerve injury in humans. After a 3-week contact period with the sciatic nerve in female Sprague Dawley rats, we could demonstrate severe intra- and perineural scarring that resulted in grade 3 adhesions and major impairments in the electrophysiological peak amplitude compared with sham control (P=0.0478). Immunohistochemical analysis of the nerve structure revealed vigorous nerve inflammation and recruitment of T cells and macrophages. Also, distinct nerve degeneration was determined by immunostaining. These pathological alterations were further reflected in significant functional deficiencies, as determined by the analysis of relevant gait parameters as well as the quantification of the sciatic functional index starting at week 1 post-operation (P<0.01). Moreover, with this model we could, for the first time, demonstrate not only the primary formation, but also the recurrence, of severe adhesions 1 week after glue removal, imitating a major clinical challenge. As a comparison, we tested a published model for generating perineural fibrotic adhesions, which did not result in significant pathological changes. Taken together, we established an easily reproducible and reliable rat model for peripheral nerve scarring that allows for the effective testing of new therapeutic strategies.
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Affiliation(s)
- Angela Lemke
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria .,Austrian Cluster for Tissue Regeneration, Austria
| | - Carina Penzenstadler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria
| | - James Ferguson
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria.,Austrian Cluster for Tissue Regeneration, Austria
| | - Dominika Lidinsky
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria
| | - Rudolf Hopf
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria
| | - Monika Bradl
- Department for Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, Vienna 1090, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria.,Austrian Cluster for Tissue Regeneration, Austria
| | - Susanne Wolbank
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria.,Austrian Cluster for Tissue Regeneration, Austria
| | - Thomas Hausner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Donaueschingenstraße 13, Vienna 1200, Austria.,Department of Traumatology, Lorenz Böhler Hospital, Donaueschingenstraße 13, Vienna 1200, Austria.,Department for Trauma Surgery and Sports Traumatology, Paracelsus Medical University, Strubergasse 21, Salzburg 5020, Austria
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Cherubino M, Pellegatta I, Crosio A, Valdatta L, Geuna S, Gornati R, Tos P. Use of human fat grafting in the prevention of perineural adherence: Experimental study in athymic mouse. PLoS One 2017; 12:e0176393. [PMID: 28445518 PMCID: PMC5406022 DOI: 10.1371/journal.pone.0176393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/10/2017] [Indexed: 11/18/2022] Open
Abstract
Perineural adherences represent a problem after surgery involving peripheral neural system. Fat-grafting with adipose derived stem cells (ASCs) with their pro-regenerative characteristics can be important to prevent the neural damage or to facilitate the neural regeneration. Our idea was to use the fat-grafting as an anti-adherence device and test its efficacy on a postsurgical scar animal model and comparing to an antiadhesive gel. 32 athymic mice were operated under magnification, we exposed both sciatic nerves. We randomly divided all sciatic nerves into four experimental groups: burning (1), burning + carboxy-methylcellulose and poly- ethylene oxide (CMC-PEO) (2) + human adipose fat tissue (3), control group (4). Bio-mechanical evaluation was performed to measure the peak force required to pull out the nerve from the muscular bed. Results: in the CMC-PEO group the peak pull out force was 0.37 Newton. In the fat grafted group we registered a peak pull out force of 0.35 N (t Student 0.913). In burning group the force necessary to tear the nerve apart was markedly superior (0.46 N). In control group, we reported the minimal strength (0.31 N) to slide the nerve from the tissue. Histologically, in the group treated with fat-grating, a thinner scar layer was highlighted. Considering the results of this study we can support the efficacy in animal experimental model of fat graft as an anti-adherence device in peripheral nerve surgery.
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Affiliation(s)
- Mario Cherubino
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Igor Pellegatta
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- * E-mail:
| | - Alessandro Crosio
- Reconstructive Microsurgery Unit, Traumatology Department, CTO Hospital, Turin, Italy
| | - Luigi Valdatta
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Stefano Geuna
- Human Anatomy Laboratory, Clinical and Biological Sciences Department, University of Turin, AOU San Luigi Gonzaga, Orbassano, Italy
| | - Rosalba Gornati
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Pierluigi Tos
- Department of Orthopedic, Traumatologic and Hand Surgery, ASST Gaetano Pini, Milan, Italy
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Jia H, Huang Z, Li Z, Zheng Z, Wang X. One-pot synthesis of highly mechanical and redox-degradable polyurethane hydrogels based on tetra-PEG and disulfide/thiol chemistry. RSC Adv 2016. [DOI: 10.1039/c6ra04320h] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A series of tetra-PEG polyurethane hydrogels with tunable redox-degradability and a high compressive fracture strength has been synthesized by a one-pot method.
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Affiliation(s)
- Haiyan Jia
- School of Chemistry and Chemical Engineering (SCCE)
- The State Key Laboratory of Metal Matrix Composites
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
| | - Zhangjun Huang
- School of Chemistry and Chemical Engineering (SCCE)
- The State Key Laboratory of Metal Matrix Composites
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
| | - Zhao Li
- School of Chemistry and Chemical Engineering (SCCE)
- The State Key Laboratory of Metal Matrix Composites
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
| | - Zhen Zheng
- School of Chemistry and Chemical Engineering (SCCE)
- The State Key Laboratory of Metal Matrix Composites
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
| | - Xinling Wang
- School of Chemistry and Chemical Engineering (SCCE)
- The State Key Laboratory of Metal Matrix Composites
- Shanghai Jiao Tong University
- Shanghai 200240
- P. R. China
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