Multifunctional composite hydrogel bolus with combined self-healing, antibacterial and adhesive functions for radiotherapy

Self-Crosslinking AuNPs Composite Hydrogel Bolus for Radiophotothermal Therapy

Radiophotothermal therapy is a promising treatment for superficial tumors. Traditional radiotherapy requires tissue boluses on the patient's skin to increase therapeutic effectiveness due to the dose-buildup effect of high-energy radiation. However, combining radiotherapy with photothermal therapy leads to uncertainties as the low-penetration near-infrared light dose is reduced after penetrating the bolus. To enhance precision and effectiveness, this study introduces a novel bolus made of AuNPs@poly(AM-THMA-DMAEMA) composite hydrogel. This hydrogel is prepared through a one-pot method involving the reduction of trihydrate chloroauric acid (HAuCl4·3H2O) and copolymerization of acrylamide (AM) and N-[Tris(hydroxymethyl)methyl]acrylamide (THMA) in a redox system with dimethylaminoethyl methacrylate (DMAEMA) and potassium persulfate (KPS). The gold nanoparticles (AuNPs) improve the mechanical strength (tensile strength of 320.84 kPa, elongation at break of 830%) and antibacterial properties (>99% against Staphylococcus aureus). The local surface plasmon resonance (LSPR) effect of AuNPs enables the hydrogel to absorb near-infrared light for precise monitoring of the infrared radiation dose. The hydrogel's biocompatibility is enhanced by the absence of additional crosslinking agents, and its excellent surface adhesion strength is due to numerous hydrogen bonds and electrostatic interactions. This study offers new possibilities for nanoparticle composite hydrogels as tissue boluses, achieving high precision and efficiency in radiophotothermal therapy.

Imageable Brachytherapy with Chelator-Free Radiolabeling Hydrogel

Brachytherapy stands as an essential clinical approach for combating locally advanced tumors. Here, an injectable brachytherapy hydrogel is developed for the treatment of both local and metastatic tumor. Fe-tannins nanoparticles are efficiently and stably radiolabeled with clinical used therapeutic radionuclides (such as 131I, 90Y, 177Lu, and 225Ac) without a chelator, and then chemically cross-linked with 4-armPEG-SH to form brachytherapy hydrogel. Upon intratumoral administration, magnetic resonance imaging (MRI) signal from ferric ions embedded within the hydrogel directly correlates with the retention dosage of radionuclides, which can real-time monitor radionuclides emitting short-range rays in vivo without penetration limitation during brachytherapy. The hydrogel's design ensures the long-term tumor retention of therapeutic radionuclides, leading to the effective eradication of local tumor. Furthermore, the radiolabeled hydrogel is integrated with an adjuvant to synergize with immune checkpoint blocking therapy, thereby activating potent anti-tumor immune responses and inhibiting metastatic tumor growth. Therefore, this work presents an imageable brachytherapy hydrogel for real-time monitoring therapeutic process, and expands the indications of brachytherapy from treatment of localized tumors to metastatic tumors.

Amphiphilic nanofibrillated cellulose/polyurethane composites with antibacterial, antifouling and self-healing properties for potential catheter applications

This study focuses on enhancing interventional medical devices, specifically catheters, using a novel composite material. Challenges like corrosion and contamination in vivo, often caused by body fluids' pH, bacteria, and proteins, lead to mechanical damage, bacterial colonization, and biofilm formation on devices like catheters. The objective of this study was to prepare a versatile composite (HFs) by designing polyurethanes (HPU) with an ionic chain extender (HIID) and blending them with amphiphilic nanofibrillated cellulose (Am-CNF). The composite leverages dynamic interactions such as hydrogen bonding and electrostatic forces, as evidenced by Molecular Mechanics (MM) calculations. The H4F0.75 composite exhibited exceptional properties: 99 % length recovery post 600 stretching cycles at 100 % strain, rapid self-healing in artificial urine, high bactericidal activity, and excellent cell viability. Moreover, mechanical aging tests and UV-vis spectral analysis confirmed the material's durability and safety. These findings suggest that the HFs composite holds significant promise for improving catheters' performance in medical applications.

Individualized 3D-printed bolus promotes precise postmastectomy radiotherapy in patients receiving breast reconstruction

Purpose

To evaluate the efficacy and safety of 3D-printed tissue compensations in breast cancer patients receiving breast reconstruction and postmastectomy radiotherapy (PMRT).

Methods and materials

We enrolled patients with breast cancer receiving breast reconstruction and PMRT. The dose distribution of target and skin, conformability, and dose limit of organs at risk (OARs) were collected to evaluate the efficacy of the 3D-printed bolus. Radiation Therapy Oncology Group (RTOG) radiation injury classification was used to evaluated the skin toxicities.

Results

A total of 30 patients diagnosed between October 2019 to July 2021 were included for analysis. Among all the patients, the 3D-printed bolus could ensure the dose coverage of planning target volume (PTV) [homogeneity index (HI) 0.12 (range: 0.08-0.18)], and the mean doses of D99%, D98%, D95%, D50%, D2% and Dmean were 4606.29cGy, 4797.04cGy, 4943.32cGy, 5216.07cGy, 5236.10cGy, 5440.28cGy and 5462.10cGy, respectively. The bolus demonstrated an excellent conformability, and the mean air gaps between the bolus and the chest wall in five quadrants were 0.04cm, 0.18cm, 0.04cm, 0.04cm and 0.07cm, respectively. In addition, the bolus had acceptable dosage limit of OARs [ipsilateral lung: Dmean 1198.68 cGy, V5 46.10%, V20 21.66%, V30 16.31%); heart: Dmean 395.40 cGy, V30 1.02%, V40 0.22%; spinal cord planning risk volume (PRV): Dmax 1634 cGy] and skin toxicity (grade 1, 76.0%; grade 2, 21.0%; grade 3, 3.3%).

Conclusion

The 3D-printed bolus offers advantages in terms of dose uniformity and controllable skin toxicities in patients receiving breast reconstruction and PMRT. Further research is needed to comprehensively evaluate the effectiveness of the 3Dprinted bolus in this patient subset.

Construction of an antibacterial hydrogel based on diammonium glycyrrhizinate and gallic acid for bacterial- infected wound healing

The current antibacterial wound dressings with antibiotic substances or metal bactericidal agents may lead to severe multidrug resistance and poor biocompatibilities. Herein, we report an inherent antibacterial hydrogel constructed by only two naturally small molecules gallic acid (GA) and diammonium glycyrrhizinate (DG) for promoting Staphylococcus aureus (S. aureus)-infected wound healing. The resultant GAD hydrogel can be fabricated by co-assembly of these two materials through simple steps. Thanks to the incorporation of GA and DG, GAD hydrogel enabled a strong mechanical performance and great self-healing property with a sustained-release of drugs into skin wounds. Moreover, the cell viability assays showed that GAD hydrogel had good cytocompatibility by promoting cell proliferation and migration. In addition, GAD hydrogel had broad antibacterial efficiency against both Gram-positive and Gram-negative bacteria. Taken together, GAD hydrogel is a promising dressing to accelerate bacterial-infected wound healing through reconstructing an intact and thick epidermis without antibiotics or cytokines.

Biological Effects, Applications and Design Strategies of Medical Polyurethanes Modified by Nanomaterials

Polyurethane (PU) has wide application and popularity as medical apparatus due to its unique structural properties relationship. However, there are still some problems with medical PUs, such as a lack of functionality, insufficient long-term implantation safety, undesired stability, etc. With the rapid development of nanotechnology, the nanomodification of medical PU provides new solutions to these clinical problems. The introduction of nanomaterials could optimize the biocompatibility, antibacterial effect, mechanical strength, and degradation of PUs via blending or surface modification, therefore expanding the application range of medical PUs. This review summarizes the current applications of nano-modified medical PUs in diverse fields. Furthermore, the underlying mechanisms in efficiency optimization are analyzed in terms of the enhanced biological and mechanical properties critical for medical use. We also conclude the preparation schemes and related parameters of nano-modified medical PUs, with discussions about the limitations and prospects. This review indicates the current status of nano-modified medical PUs and contributes to inspiring novel and appropriate designing of PUs for desired clinical requirements.

Design strategies for adhesive hydrogels with natural antibacterial agents as wound dressings: Status and trends

The wound healing process is usually susceptible to different bacterial infections due to the complex physiological environment, which significantly impairs wound healing. The topical application of antibiotics is not desirable for wound healing because the excessive use of antibiotics might cause bacteria to develop resistance and even the production of super bacteria, posing significant harm to human well-being. Wound dressings based on adhesive, biocompatible, and multi-functional hydrogels with natural antibacterial agents have been widely recognized as effective wound treatments. Hydrogels, which are three-dimensional (3D) polymer networks cross-linked through physical interactions or covalent bonds, are promising for topical antibacterial applications because of their excellent adhesion, antibacterial properties, and biocompatibility. To further improve the healing performance of hydrogels, various modification methods have been developed with superior biocompatibility, antibacterial activity, mechanical properties, and wound repair capabilities. This review summarizes hundreds of typical studies on various ingredients, preparation methods, antibacterial mechanisms, and internal antibacterial factors to understand adhesive hydrogels with natural antibacterial agents for wound dressings. Additionally, we provide prospects for adhesive and antibacterial hydrogels in biomedical applications and clinical research.

3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer

Purpose

To investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer.

Methods and materials

In the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including D_min, D_max, D_mean, D_95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects.

Results

In preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): D_min 4967(4789–5099) cGy, D_max 5447(5369–5589) cGy, D_mean 5236(5171–5323) cGy, D_95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: D_mean 1341(1208–1385) cGy, V₅ 48.06%(39.75%–48.97%), V₂₀ 24.55%(21.58%–26.93%), V₃₀ 18.40%(15.96%–19.16%); heart: D_mean 339(138–640) cGy, V₃₀ 1.10%(0%–6.14%), V₄₀ 0.38%(0%–4.39%); spinal cord PRV: D_max 639(389–898) cGy). The skin doses in vivo were D_theory 208.85(203.16–212.53) cGy, D_fact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%.

Conclusion

A 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.

Effects of Cu2+/Zn2+ on the electrochemical performance of polyacrylamide hydrogels as advanced flexible electrode materials

Previously, solid-state electrode materials have been utilized for the fabrication of energy storage devices; however, their application is impeded by their brittle nature and ion mobility problems. To address issues faced in such a modern era where energy saving and utility is of prior importance, a novel approach has been applied for the preparation of electrode materials based on polyacrylamide hydrogels embedded with reduced graphene oxide and transition metals, namely, Cu²⁺ and Zn²⁺. The fabricated hydrogel exhibits high electrical properties and flexibility that make it a favorable candidate to be used in energy storage devices, where both elastic and electrical properties are desired. For the first time, a multi-cross-linked polyacrylamide hydrogel was constructed and compared in the presence of other electro-active materials such as reduced graphene oxide and transition metals. Polyacrylamide hydrogels embedded with reduced graphene oxide demonstrate excellent electrical properties such as specific capacitance, least impedance, low phase angle shift and AC conductivity of 22.92 F g^-1, 2115 Ω, 2.88° and 0.67 μδ m^-1 respectively as compared to Cu²⁺- and Zn²⁺-loaded hydrogels, which block all available active sites causing an increase in impedance with a parallel decrease in capacitance. The capacitance retention and coulombic efficiency calculated were 88.22% and 77.23% respectively, indicating high stability up to 150 cycles at 0.1 A g^-1. Storage moduli obtained were 10.52 kPa, which infers the more elastic nature of the hydrogel loaded with graphene oxide than that of other synthesized hydrogels.

3D Printing Polymer-based Bolus Used for Radiotherapy

Bolus is a kind of auxiliary device used in radiotherapy for the treatment of superficial lesions such as skin cancer. It is commonly used to increase skin dose and overcome the skin-sparing effect. Despite the availability of various commercial boluses, there is currently no bolus that can form full contact with irregular surface of patients' skin, and incomplete contact would result in air gaps. The resulting air gaps can reduce the surface radiation dose, leading to a discrepancy between the delivered dose and planned dose. To avoid this limitation, the customized bolus processed by three-dimensional (3D) printing holds tremendous potential for making radiotherapy more efficient than ever before. This review mainly summarized the recent development of polymers used for processing bolus, 3D printing technologies suitable for polymers, and customization of 3D printing bolus. An ideal material for customizing bolus should not only have the feature of 3D printability for customization, but also possess radiotherapy adjuvant performance as well as other multiple compound properties, including tissue equivalence, biocompatibility, antibacterial activity, and antiphlogosis.

An excellent antibacterial and high self-adhesive hydrogel can promote wound fully healing driven by its shrinkage under NIR

The lacks of antibacterial properties, low adhesion and delayed wound healing of the hydrogel wound dressings limit their applications in wound treatment. To resolve these, a novel hydrogel composed of polydopamine (PDA), Ag and graphene oxide (GO) is fabricated for wound dressing via the chemical crosslinking of N-isopropylacrylamide (NIPAM) and N,N'-methylene bisacrylamide (BIS). The prepared hydrogel containing PDA@Ag5GO1 (Ag5GO1 denotes the mass ratio between Ag and GO is 5:1) exhibits effective antibacterial properties and high inhibition rate against E. coli and S. aureus. It shows high adhesion ability to various substrate materials, implying a simpler method to the wound obtained by self-fixing rather than suturing. More important, it can produce strong contractility under the irradiation of near-infrared light (NIR), exerting a centripetal force that helps accelerate wound healing. Thus, the hydrogel containing a high concentration PDA@Ag5GO1 irradiated by NIR can completely repair the wound defect (1.0 × 1.0 cm²) within 15 days, the wound healing rate can reach 100%, which was far higher than other groups. Taken together, the new hydrogel with excellent antibacterial, high adhesion and strong contractility will subvert the traditional treatment methods on wound defect, extending its new application range in wound dressing.

Three-Dimensional Printing Chitosan-Based Bolus Used for Radiotherapy

A bolus is a kind of tissue equivalent material used in radiotherapy for treating superficial lesions. Despite the availability of various commercial boluses, it is hard for them to form full contact with the irregular surface of patients' skin, such as the scalp, nose, and ear, resulting in air gaps and leading to a discrepancy between the delivered dose and planned dose. To solve this problem, we provided a photocurable bioink created from chitosan (CHI) for digital light processing (DLP) three-dimensional (3D) printing the bolus in radiotherapy application. The chitosan-based bioink (CHI-MA) was obtained by a methacrylation process using methacrylic anhydride (MA). Photosensitive crosslinkers with different molecular weights were introduced into the bioink. The photocuring efficiency and mechanical properties of CHI-MA hydrogels can be well modulated by varying the crosslinkers. This CHI-MA bioink allowed us to create complex structures with reliable biocompatibility, good flexibility, and excellent structural stability. Furthermore, the nose bolus processed by 3D printing this bioink proved to be a good fit for the nose model and showed a desirable radiotherapy effect. This suggests that DLP 3D printing of the CHI-MA bioink would be a promising approach to obtain the customized bolus in the application of radiotherapy.

The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy

During the procedure of radiotherapy for superficial tumors, the key to treatment is to ensure that the skin surface receives an adequate radiation dose. However, due to the presence of the built-up effect of high-energy rays, equivalent tissue compensators (boluses) with appropriate thickness should be placed on the skin surface to increase the target radiation dose. Traditional boluses do not usually fit the skin perfectly. Wet gauze is variable in thickness day to day which results in air gaps between the skin and the bolus. These unwanted but avoidable air gaps lead to a decrease of the radiation dose in the target area and can have a poor effect on the outcome. Three-dimensional (3D) printing, a new rising technology named “additive manufacturing” (AM), could create physical models with specific shapes from digital information by using special materials. It has been favored in many fields because of its advantages, including less waste, low-cost, and individualized design. It is not an exception in the field of radiotherapy, personalized boluses made through 3D printing technology also make up for a number of shortcomings of the traditional commercial bolus. Therefore, an increasing number of researchers have tried to use 3D-printed boluses for clinical applications rather than commercial boluses. Here, we review the 3D-printed bolus’s material selection and production process, its clinical applications, and potential radioactive dermatitis. Finally, we discuss some of the challenges that still need to be addressed with the 3D-printed boluses.

Injectable Nanocomposite Hydrogels for Cancer Therapy

Hydrogel is a kind of 3D polymer network with strong swelling ability in water and appropriate mechanical and biological properties, which make it feasible to maintain bioactive substances and has promising applications in the fields of biomaterials, soft machines, and artificial tissues. Unfortunately, traditional hydrogels prepared by chemical crosslinking have poor mechanical properties and limited functions, which limit their further application. In recent years, with the continuous development of nanoparticle research, more and more studies have combined nanoparticles with hydrogels to make up for the shortcomings of traditional hydrogels. In this article, the types and functions of hydrogels and nanomaterials are introduced first, as well as the functions and applications of injectable nanocomposite hydrogels (INHs), then the latest progress of INHs for cancer treatment is reviewed, some existing problems are summarized, and the application prospect of NHs is prospected.

Mechanically Robust, Self-Healing, Polymer Blends and Polymer/Small Molecule Blend Materials with High Antibacterial Activity

There is a growing demand for antibacterial materials around the world in recent years because they can be used for preventing pathogen infection, which is one of the major threats to human health. However, the mechanical damage of the antibacterial materials may weaken their protective effect since bacteria can invade through the cracks of the material. Therefore, antibacterial materials with self-healing ability, in which the mechanical damage can be spontaneously healed, exhibit better reliability and a longer lifespan. In this article, we prepared a series of low-cost antibacterial polymer blends and polymer/small molecule blend materials with excellent self-healing ability and high mechanical strength by a one-pot reaction under mild conditions. These materials were facilely obtained by blending a tiny amount of commercialized cationic antibacterial chemicals, poly(ethylene imine) (PEI) or cetyltrimethylammonium bromide (CTAB), into a self-healing, mechanically robust polymer, poly(ether-thioureas) (PETU). It can be found that they can effectively kill Escherichia coli (Gram-negative) and Staphylococcus aureus (Gram-positive) on their surface. Meanwhile, the distinguished advantages of PETU, including self-healing property, excellent mechanical robustness, recyclability, and transparency, were perfectively maintained. Furthermore, it was shown that their cytotoxicity was satisfactory and their hemolytic activity was insignificant. The above advantages of the blend materials suggested their potential applications in health care, food industry, and environmental hygiene.