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Patil TV, Jin H, Dutta SD, Aacharya R, Chen K, Ganguly K, Randhawa A, Lim KT. Zn@TA assisted dual cross-linked 3D printable glycol grafted chitosan hydrogels for robust antibiofilm and wound healing. Carbohydr Polym 2024; 344:122522. [PMID: 39218566 DOI: 10.1016/j.carbpol.2024.122522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024]
Abstract
Rapid regeneration of the injured tissue or organs is necessary to achieve the usual functionalities of the damaged parts. However, bacterial infections delay the regeneration process, a severe challenge in the personalized healthcare sector. To overcome these challenges, 3D-printable multifunctional hydrogels of Zn/tannic acid-reinforced glycol functionalized chitosan for rapid wound healing were developed. Polyphenol strengthened intermolecular connections, while glutaraldehyde stabilized 3D-printed structures. The hydrogel exhibited enhanced viscoelasticity (G'; 1.96 × 104 Pa) and adhesiveness (210 kPa). The dual-crosslinked scaffolds showed remarkable antibacterial activity against Bacillus subtilis (∼81 %) and Escherichia coli (92.75 %). The hydrogels showed no adverse effects on human dermal fibroblasts (HDFs) and macrophages (RAW 264.7), indicating their superior biocompatibility. The Zn/TA-reinforced hydrogels accelerate M2 polarization of macrophages through the activation of anti-inflammatory transcription factors (Arg-1, VEGF, CD163, and IL-10), suggesting better immunomodulatory effects, which is favorable for rapid wound regeneration. Higher collagen deposition and rapid re-epithelialization occurred in scaffold-treated rat groups vis-à-vis controls, demonstrating superior wound healing. Taken together, the developed multifunctional hydrogels have great potential for rapidly regenerating bacteria-infected wounds in the personalized healthcare sector.
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Affiliation(s)
- Tejal V Patil
- Department of Biosystems Engineering, Kangwon National University, Chuncheon-24341, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon-24341, Republic of Korea
| | - Hexiu Jin
- Department of Plastic and Traumatic Surgery, Capital Medical University, Beijing-10096, China
| | - Sayan Deb Dutta
- Department of Biosystems Engineering, Kangwon National University, Chuncheon-24341, Republic of Korea; Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, Sacramento, California-95817, United States
| | - Rumi Aacharya
- Department of Biosystems Engineering, Kangwon National University, Chuncheon-24341, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon-24341, Republic of Korea
| | - Kehan Chen
- Department of Plastic and Traumatic Surgery, Capital Medical University, Beijing-10096, China
| | - Keya Ganguly
- Department of Biosystems Engineering, Kangwon National University, Chuncheon-24341, Republic of Korea; Institute of Forest Science, Kangwon National University, Chuncheon-24341, Republic of Korea
| | - Aayushi Randhawa
- Department of Biosystems Engineering, Kangwon National University, Chuncheon-24341, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon-24341, Republic of Korea
| | - Ki-Taek Lim
- Department of Biosystems Engineering, Kangwon National University, Chuncheon-24341, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon-24341, Republic of Korea; Institute of Forest Science, Kangwon National University, Chuncheon-24341, Republic of Korea.
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Abouelnaga AM, El Nahrawy AM. Spectroscopic investigation, dielectric and antimicrobial properties of chitin-cellulose@ZnO/CuO conductive nanocomposites. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 320:124646. [PMID: 38875926 DOI: 10.1016/j.saa.2024.124646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/12/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
In this research, we fabricated a functional conductive nanocomposite with valuable properties through a chitin (CH) and cellulose (CE) polymerization process, incorporating ZnO/(0.1, 0.2, 0.3 mol.%) CuO bioactive nanoparticles. These bioactive nanoparticles, synthesized through sol-gel and polymerization interactions, greatly enhanced the structural, dielectric, and antimicrobial characteristics of CH-CE@ZnO/CuO conductive nanocomposites. The morphological analysis revealed that these nanoparticles, with diameters ranging from 11-25 nm, formed covalent bonds with the membrane matrix, bolstering the conductive nanocomposites ' structural integrity and dielectric performance. The dielectric properties of the conductive nanocomposites were significantly enhanced by the even distribution of ZnO/CuO nanoparticles within the CH-CE composite. Additionally, antimicrobial assessments demonstrated that the CH-CE@ZnO/CuO conductive nanocomposites displayed significant antibacterial properties against the Escherichia coli and Staphylococcus aureus, showcasing their potential as active packaging materials for electronic, biosensors, and sustainable applications.
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Affiliation(s)
| | - Amany M El Nahrawy
- Solid State Physics Department, Physics Research Institute, National Research Centre (NRC), 33 El-Bohouth St., Dokki, Cairo 12622, Egypt.
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Li S, Dan X, Chen H, Li T, Liu B, Ju Y, Li Y, Lei L, Fan X. Developing fibrin-based biomaterials/scaffolds in tissue engineering. Bioact Mater 2024; 40:597-623. [PMID: 39239261 PMCID: PMC11375146 DOI: 10.1016/j.bioactmat.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/07/2024] Open
Abstract
Tissue engineering technology has advanced rapidly in recent years, offering opportunities to construct biologically active tissues or organ substitutes to repair or even enhance the functions of diseased tissues and organs. Tissue-engineered scaffolds rebuild the extracellular microenvironment by mimicking the extracellular matrix. Fibrin-based scaffolds possess numerous advantages, including hemostasis, high biocompatibility, and good degradability. Fibrin scaffolds provide an initial matrix that facilitates cell migration, differentiation, proliferation, and adhesion, and also play a critical role in cell-matrix interactions. Fibrin scaffolds are now widely recognized as a key component in tissue engineering, where they can facilitate tissue and organ defect repair. This review introduces the properties of fibrin, including its composition, structure, and biology. In addition, the modification and cross-linking modes of fibrin are discussed, along with various forms commonly used in tissue engineering. We also describe the biofunctionalization of fibrin. This review provides a detailed overview of the use and applications of fibrin in skin, bone, and nervous tissues, and provides novel insights into future research directions for clinical treatment.
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Affiliation(s)
- Songjie Li
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xin Dan
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Han Chen
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Tong Li
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Bo Liu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Yikun Ju
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yang Li
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Lanjie Lei
- Key Laboratory of Artificial Organs and Computational Medicine in Zhejiang Province, Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, 310015, China
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
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Kruczkowska W, Kłosiński KK, Grabowska KH, Gałęziewska J, Gromek P, Kciuk M, Kałuzińska-Kołat Ż, Kołat D, Wach RA. Medical Applications and Cellular Mechanisms of Action of Carboxymethyl Chitosan Hydrogels. Molecules 2024; 29:4360. [PMID: 39339355 PMCID: PMC11433660 DOI: 10.3390/molecules29184360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/02/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Carboxymethyl chitosan (CMCS) hydrogels have been investigated in biomedical research because of their versatile properties that make them suitable for various medical applications. Key properties that are especially valuable for biomedical use include biocompatibility, tailored solid-like mechanical characteristics, biodegradability, antibacterial activity, moisture retention, and pH stimuli-sensitive swelling. These features offer advantages such as enhanced healing, promotion of granulation tissue formation, and facilitation of neutrophil migration. As a result, CMCS hydrogels are favorable materials for applications in biopharmaceuticals, drug delivery systems, wound healing, tissue engineering, and more. Understanding the interactions between CMCS hydrogels and biological systems, with a focus on their influence on cellular behavior, is crucial for leveraging their versatility. Because of the constantly growing interest in chitosan and its derivative hydrogels in biomedical research and applications, the present review aims to provide updated insights into the potential medical applications of CMCS based on recent findings. Additionally, we comprehensively elucidated the cellular mechanisms underlying the actions of these hydrogels in medical settings. In summary, this paper recapitulates valuable data gathered from the current literature, offering perspectives for further development and utilization of carboxymethyl hydrogels in various medical contexts.
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Affiliation(s)
- Weronika Kruczkowska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
| | - Karol Kamil Kłosiński
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
| | - Katarzyna Helena Grabowska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
| | - Julia Gałęziewska
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
| | - Piotr Gromek
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
| | - Mateusz Kciuk
- Department of Molecular Biotechnology and Genetics, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland;
| | - Żaneta Kałuzińska-Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland
| | - Damian Kołat
- Department of Biomedicine and Experimental Surgery, Faculty of Medicine, Medical University of Lodz, Narutowicza 60, 90-136 Lodz, Poland; (W.K.); (K.H.G.); (J.G.); (P.G.); (Ż.K.-K.); (D.K.)
- Department of Functional Genomics, Faculty of Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland
| | - Radosław A. Wach
- Institute of Applied Radiation Chemistry, Faculty of Chemistry, Lodz University of Technology, Wroblewskiego 15, 93-590 Lodz, Poland
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Tang X, Wang Y, Liu N, Deng X, Zhou Z, Yu C, Wang Y, Fang K, Wu T. Methacrylated Carboxymethyl Chitosan Scaffold Containing Icariin-Loaded Short Fibers for Antibacterial, Hemostasis, and Bone Regeneration. ACS Biomater Sci Eng 2024; 10:5181-5193. [PMID: 38935742 DOI: 10.1021/acsbiomaterials.4c00707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Bone defects typically result in bone nonunion, delayed or nonhealing, and localized dysfunction, and commonly used clinical treatments (i.e., autologous and allogeneic grafts) have limited results. The multifunctional bone tissue engineering scaffold provides a new treatment for the repair of bone defects. Herein, a three-dimensional porous composite scaffold with stable mechanical support, effective antibacterial and hemostasis properties, and the ability to promote the rapid repair of bone defects was synthesized using methacrylated carboxymethyl chitosan and icariin-loaded poly-l-lactide/gelatin short fibers (M-CMCS-SFs). Icariin-loaded SFs in the M-CMCS scaffold resulted in the sustained release of osteogenic agents, which was beneficial for mechanical reinforcement. Both the porous structure and the use of chitosan facilitate the effective absorption of blood and fluid exudates. Moreover, its superior antibacterial properties could prevent the occurrence of inflammation and infection. When cultured with bone mesenchymal stem cells, the composite scaffold showed a promotion in osteogenic differentiation. Taken together, such a multifunctional composite scaffold showed comprehensive performance in antibacterial, hemostasis, and bone regeneration, thus holding promising potential in the repair of bone defects and related medical treatments.
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Affiliation(s)
- Xunmeng Tang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textile & Clothing, Collaborative Innovation Center for Eco-textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao 266071, China
| | - Yawen Wang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textile & Clothing, Collaborative Innovation Center for Eco-textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao 266071, China
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao 266071, China
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Na Liu
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao 266071, China
| | - Xinyuan Deng
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textile & Clothing, Collaborative Innovation Center for Eco-textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao 266071, China
| | - Ziyi Zhou
- Department of Plastic, Reconstructive and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Chenghao Yu
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
| | - Yuanfei Wang
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao 266001, China
| | - Kuanjun Fang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textile & Clothing, Collaborative Innovation Center for Eco-textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao 266071, China
- Laboratory for Manufacturing Low Carbon and Functionalized Textiles in the Universities of Shandong Province, State Key Laboratory for Biofibers and Eco-textiles, College of Textiles & Clothing, Qingdao University, Qingdao 266071, China
| | - Tong Wu
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textile & Clothing, Collaborative Innovation Center for Eco-textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao 266071, China
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao 266071, China
- The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266000, China
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Liang Y, Wu S, Lin L, Jia P, Zhong Z. Solvent-assisted strategy for the design of multifunctional and ultrafast healable eutectogels. POLYMER 2024; 308:127392. [DOI: 10.1016/j.polymer.2024.127392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
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7
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Zhang P, Wang T, Qian J, Qin H, Liu P, Xiong A, Udduttula A, Wang D, Zeng H, Chen Y. An injectable magnesium-coordinated phosphate chitosan-based hydrogel loaded with vancomycin for antibacterial and osteogenesis in the treatment of osteomyelitis. Regen Biomater 2024; 11:rbae049. [PMID: 38919844 PMCID: PMC11196881 DOI: 10.1093/rb/rbae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
Microbial infections of bones, particularly after joint replacement surgery, are a common occurrence in clinical settings and often lead to osteomyelitis (OM). Unfortunately, current treatment approaches for OM are not satisfactory. To address this issue, this study focuses on the development and evaluation of an injectable magnesium oxide (MgO) nanoparticle (NP)-coordinated phosphocreatine-grafted chitosan hydrogel (CMPMg-VCM) loaded with varying amounts of vancomycin (VCM) for the treatment of OM. The results demonstrate that the loading of VCM does not affect the formation of the injectable hydrogel, and the MgO-incorporated hydrogel exhibits anti-swelling properties. The release of VCM from the hydrogel effectively kills S.aureus bacteria, with CMPMg-VCM (50) showing the highest antibacterial activity even after prolonged immersion in PBS solution for 12 days. Importantly, all the hydrogels are non-toxic to MC3T3-E1 cells and promote osteogenic differentiation through the early secretion of alkaline phosphatase and calcium nodule formation. Furthermore, in vivo experiments using a rat OM model reveal that the CMPMg-VCM hydrogel effectively kills and inhibits bacterial growth, while also protecting the infected bone from osteolysis. These beneficial properties are attributed to the burst release of VCM, which disrupts bacterial biofilm, as well as the release of Mg ions and hydroxyl by the degradation of MgO NPs, which inhibits bacterial growth and prevents osteolysis. Overall, the CMPMg-VCM hydrogel exhibits promising potential for the treatment of microbial bone infections.
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Affiliation(s)
- Peng Zhang
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Tiehua Wang
- Internal Medicine, Shenzhen New Frontier United Family Hospital, Shenzhen 518031, China
| | - Junyu Qian
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Haotian Qin
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Peng Liu
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Ao Xiong
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Anjaneyulu Udduttula
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore 632014, India
| | - Deli Wang
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hui Zeng
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Yingqi Chen
- Department of Bone & Joint Surgery, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
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Qiu R, Cai K, Zhang K, Ying Y, Hu H, Jiang G, Luo K. The current status and development trend of hydrogel application in spinal surgery. J Mater Chem B 2024; 12:1730-1747. [PMID: 38294330 DOI: 10.1039/d3tb02613b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system. Medication and surgical interventions remain the primary treatment methods for spinal conditions. However, currently available medications have limited efficacy in treating spinal surgical diseases and cannot achieve a complete cure. Furthermore, surgical intervention frequently results in inevitable alterations and impairments to the initial anatomical integrity of the spinal structure, accompanied by the consequential loss of certain physiological functionalities. Changes in spine surgery treatment concepts and modalities in the last decade have led to a deepening of minimally invasive treatment, with treatment strategies focusing more on repairing and reconstructing the patient's spine and preserving physiological functions. Therefore, developing novel and more efficient treatment strategies to reduce spinal lesions and iatrogenic injuries is essential. In recent years, significant advancements in biomedical research have led to the discovery that hydrogels possess excellent biocompatibility, biodegradability, and adjustable mechanical properties. The application of hydrogel-based biotechnology in spinal surgery has demonstrated remarkable therapeutic potential. This review presents the therapeutic strategies for spinal diseases based on hydrogel tissue engineering technology.
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Affiliation(s)
- Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Hangtian Hu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
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