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Demir-Oğuz Ö, Boccaccini AR, Loca D. Injectable bone cements: What benefits the combination of calcium phosphates and bioactive glasses could bring? Bioact Mater 2023; 19:217-236. [PMID: 35510175 PMCID: PMC9048153 DOI: 10.1016/j.bioactmat.2022.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/21/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022] Open
Abstract
Out of the wide range of calcium phosphate (CaP) biomaterials, calcium phosphate bone cements (CPCs) have attracted increased attention since their discovery in the 1980s due to their valuable properties such as bioactivity, osteoconductivity, injectability, hardening ability through a low-temperature setting reaction and moldability. Thereafter numerous researches have been performed to enhance the properties of CPCs. Nonetheless, low mechanical performance of CPCs limits their clinical application in load bearing regions of bone. Also, the in vivo resorption and replacement of CPC with new bone tissue is still controversial, thus further improvements of high clinical importance are required. Bioactive glasses (BGs) are biocompatible and able to bond to bone, stimulating new bone growth while dissolving over time. In the last decades extensive research has been performed analyzing the role of BGs in combination with different CaPs. Thus, the focal point of this review paper is to summarize the available research data on how injectable CPC properties could be improved or affected by the addition of BG as a secondary powder phase. It was found that despite the variances of setting time and compressive strength results, desirable injectable properties of bone cements can be achieved by the inclusion of BGs into CPCs. The published data also revealed that the degradation rate of CPCs is significantly improved by BG addition. Moreover, the presence of BG in CPCs improves the in vitro osteogenic differentiation and cell response as well as the tissue-material interaction in vivo. Properties of injectable calcium phosphate bone cements and bioactive glasses are discussed. Benefits that BG addition to CPC could bring are highlighted. Desirable injectable properties of bone cements can be achieved by the inclusion of BGs into CPCs. The presence of BG in CPC advances in vitro and in vivo response of the composites. Future research direction of BG containing injectable CPC composites are provided.
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Topical hemostatic agents in neurosurgery, a comprehensive review: 15 years update. Neurosurg Rev 2021; 45:1217-1232. [PMID: 34734343 DOI: 10.1007/s10143-021-01684-1] [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] [Received: 06/28/2021] [Revised: 09/26/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
Hemostasis in neurosurgery is of utmost importance. Bleeding management is one of the crucial steps of each neurosurgical procedure. Several strategies, namely thermal, mechanical, electric, and chemical, have been advocated to face blood loss within the surgical field. Over time, countless hemostatic agents and devices have been proposed. Furthermore, the ever-growing recent technological innovation has made available several novel and interesting tools. Pursuant to their impact on surgical practice, we perceived the imperative to update our previous disclosure paper. Therefore, we reviewed the literature and analyzed technical data sheets of each product in order to provide an updated and comprehensive overview in regard to chemical properties, mechanisms of action, use, complications, tricks, and pitfalls of topical hemostatic agents.
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The role of hemostatic devices in neurosurgery. A systematic review. J Clin Neurosci 2021; 89:151-157. [PMID: 34119260 DOI: 10.1016/j.jocn.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemostatic methods and devices available today in neurosurgery are classified and described.
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Pradeep A, Rangasamy J, Varma PK. Recent developments in controlling sternal wound infection after cardiac surgery and measures to enhance sternal healing. Med Res Rev 2020; 41:709-724. [PMID: 33174619 DOI: 10.1002/med.21758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
One of the major risks of cardiac surgery is the occurrence of infection at the sternal wound site. Sternal wound infections are primarily classified into superficial infection and deep sternal wound infection or mediastinitis. A patient is diagnosed with mediastinitis if microorganisms are present in their mediastinal tissue/fluid or with the observation of sternal wound infection during operation and with characteristic symptoms including chest pain, fever, and purulent drainage from the mediastinum. It is usually caused by Staphylococcal organisms in 75.8% of cases and the rest is caused by gram-negative bacteria. Currently, in cardiac surgery, hemostasis is achieved using electrocautery and bone wax, and the sternum is closed using wire cerclage. Several studies show that bone wax can act as a nidus for initiation of infection and the oozing blood and hematoma at the site can promote the growth of infectious organisms. Many research groups have developed different types of biomaterials and reported on the prevention of infection and healing of the sternum. These materials are reported to have both positive and negative effects. In this review, we highlight the current clinical practices undertaken to prevent infection and bleeding as well as research progress in this field and their outcomes in controlling bleeding, infection, and enhancing sternal healing.
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Affiliation(s)
- Aathira Pradeep
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Jayakumar Rangasamy
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
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Zhang Y, Luan J, Zhang Y, Sha S, Li S, Xu S, Xu D. Preparation and Characterization of Iron-Doped Tricalcium Silicate-Based Bone Cement as a Bone Repair Material. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E3670. [PMID: 32825175 PMCID: PMC7504278 DOI: 10.3390/ma13173670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
Iron is one of the trace elements required by human body, and its deficiency can lead to abnormal bone metabolism. In this study, the effect of iron ions on the properties of tricalcium silicate bone cement (Fe/C3Ss) was investigated. It effectively solved the problems of high pH value and low biological activity of calcium silicate bone cement. The mechanical properties, in vitro mineralization ability and biocompatibility of the materials were systematically characterized. The results indicate that tricalcium silicate bone cement containing 5 mol% iron displayed good self-setting ability, mechanical properties and biodegradation performance in vitro. Compared with pure calcium silicate bone cement (C3Ss), Fe/C3Ss showed lower pH value (8.80) and higher porosity (45%), which was suitable for subsequent cell growth. Immersion test in vitro also confirmed its good ability to induce hydroxyapatite formation. Furthermore, cell culture experiments performed with Fe/C3Ss ion extracts clearly stated that the material had excellent cell proliferation abilities compared to C3Ss and low toxicity. The findings reveal that iron-doped tricalcium silicate bone cement is a promising bioactive material in bone repair applications.
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Affiliation(s)
- Yanan Zhang
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
| | - Jiapan Luan
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
| | - Yin Zhang
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
- Nanjing Haoqi Advanced Materials Co., Ltd., Nanjing 211300, China
| | - Shuai Sha
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
| | - Sha Li
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
| | - Shanqi Xu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
| | - Dongqing Xu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, China; (Y.Z.); (J.L.); (S.S.); (S.L.); (S.X.); (D.X.)
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Zhang F, Zhou M, Gu W, Shen Z, Ma X, Lu F, Yang X, Zheng Y, Gou Z. Zinc-/copper-substituted dicalcium silicate cement: advanced biomaterials with enhanced osteogenesis and long-term antibacterial properties. J Mater Chem B 2020; 8:1060-1070. [PMID: 31939984 DOI: 10.1039/c9tb02691f] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The development of bioactive Ca-silicate-based cements which may simultaneously suppress infection is promising for periapical therapy or alveolar bone defect repair. While these treatments are usually effective in the short term, many of these cements have not been designed to have an affinity with dental tissue in a prolonged anti-infectious manner and are only high alkaline in the early stages. This can lead to less favorable long-term outcomes, such as in bone repair or secondary therapy. Inspired by the strong antibacterial activity of zinc and copper ions, we developed a nonstoichiometric dicalcium silicate (C2S) substituted by 5% or 10% Zn or Cu to endow it with appropriate multifunctions. It was found that the foreign ion substitution could inhibit free CaO content and increase the pH value in the initial ∼6 h. The C2S cement only showed antibacterial activity in the early stage (6-72 h), but the C2S displayed appreciable long-term antibacterial potential against P. aeruginosa, E. faecalis and E. coli (>6 h) and S. aureus (>72 h). Moreover, the enhanced new bone regeneration by Zn substitution in C2S was confirmed in a maxillofacial bone defect model in rabbits. The increases in new bone formation adjacent to C2S-10Zn and C2S after 16 weeks of implantation were 32% and 20%, respectively. And the Tb.N values in the C2S-10Zn and C2S-10Cu groups (∼5.7 and 4.9 mm-1) were over two-fold higher than in the C2S group (∼2.0 mm-1). It is considered that Zn- or Cu-substitution in C2S is promising for applications to infectious bone repair.
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Affiliation(s)
- Feng Zhang
- Department of Stomatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China.
| | - Mingming Zhou
- Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - Weizhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - Zheng Shen
- Center of Laboratory Testing, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - Xiaohui Ma
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - Fengling Lu
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou 310058, China.
| | - Xianyan Yang
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou 310058, China.
| | - Youyang Zheng
- Department of Stomatology, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou 310008, China
| | - Zhongru Gou
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou 310058, China.
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Zhou H, Ge J, Bai Y, Liang C, Yang L. Translation of bone wax and its substitutes: History, clinical status and future directions. J Orthop Translat 2019; 17:64-72. [PMID: 31194062 PMCID: PMC6551357 DOI: 10.1016/j.jot.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
Bone wax, primarily composed of beeswax and softening agent, is a century-old material used to control bleeding of disrupted bone surfaces by acting as a mechanical barrier to seal the wound. The current bone wax products are commonly packed in easy-to-open foil in the form of sterile sticks or plates, with excellent malleability and smooth consistency, enabling cost-effective and easy handling approach for bleeding control. It has also been reported that the inert nature of bone wax causes complications including foreign body reaction, infection promotion and bone healing inhibition. With the advances in biomaterials and the market boost of bone haemostatic materials, the arena of bone wax substitute research has expanded to a wide spectrum of material formulations and forms. However, the development of substitutes of bone wax for translation is a pivotal yet challenging topic because currently a potential candidate is recommended to be just as simple to use, effective and inexpensive to produce as traditional bone wax but also be absorbable and osteogenic. This review provides an overview of bone wax including its history, clinical applications and associated complication. In addition, emerging substitutes of bone wax and outlooks of future directions including the standardised evaluation methods are also discussed as an effort to catalyse the innovation and translation of bone haemostatic agents in the near future. The translational potential of this article: Occurrence of osseous haemorrhage is common in surgically incised or traumatically fractured bone. It is essential to stop bone bleeding to avoid further pathologic consequences such as tissue necrosis and eventually mortalities due to blood loss. Medical sterile bone wax is a classical material for haemostasis of bone during orthopaedic surgeries, thoracic surgeries, neurological surgeries and so on. Along with its widespread use, complications such as foreign body reaction, bone healing inhibition and infection promotion associated with bone wax are observed. With the growing knowledge in biomaterials and the boost of market of bone haemostatic materials, bone wax substitute research is thriving. An overview of bone and its substitutes together with evolution of their design criteria is carried out in this work, providing information for the innovation and translation of bone haemostatic agents in the near future.
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Affiliation(s)
- Huan Zhou
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
- School of Mechanical Engineering, Jiangsu University of Technology, Jiangsu 213001, China
- International Research Center for Translational Orthopaedics (IRCTO), Jiangsu 215006, China
| | - Jun Ge
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
| | - Yanjie Bai
- Key Laboratory of Hebei Province for Molecular Biophysics, Institute of Biophysics, School of Sciences, Hebei University of Technology, Tianjin 300401, China
| | - Chunyong Liang
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Lei Yang
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
- International Research Center for Translational Orthopaedics (IRCTO), Jiangsu 215006, China
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Cao W, Zong S, Zhang Y, Qiu F, Tang J, Wu Z, Luan J. Preparation of a novel bone wax with modified tricalcium silicate cement and BGs. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:979-985. [PMID: 30889773 DOI: 10.1016/j.msec.2019.02.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 01/15/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Amino-grafted and vaterite-contained tricalcium silicate cement (A-V-C3S) was composited with 58S bioglass/chitosan/carboxy methyl cellulose (BG/CS/CMC, referred as BGs) to surmount the non-absorbability and infection problems of traditional bone wax. Its material, bioactive, biocompatible and antibacterial properties were systematically characterized. The results revealed that A-V-C3S/BGs possessed self-setting, injectable, mechanical and degradable abilities. A-V-C3S/BGs (1:1 g/g) was optimum owing to its higher compressive strength (9.91 MPa) and lower pH value (7.6 to 8.1) in the test groups. In vitro immersion experiment demonstrated that A-V-C3S/BGs had good hydroxyapatite formation ability, and its excellent cell adhesion, low cytotoxicity and superior cell proliferation were verified by mouse embryonic osteoblast precursor cells in cell tests. Compared with A-V-C3S, antibacterial experiment illustrated the significantly enhanced antibacterial property of A-V-C3S/BGs to Staphylococcus aureus and Escherichia coli.
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Affiliation(s)
- Weijing Cao
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 210009, China
| | - Shouyang Zong
- Department of Clinical Laboratory, People's Hospital of Jinhu Country, China
| | - Yin Zhang
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 210009, China; Nanjing Haoqi Advanced Materials Co., Ltd., Nanjing 211300, China.
| | - Fan Qiu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; The State Key Laboratory of Pharmaceutical Biotechnology, College of Life Science, Nanjing University, Nanjing 210093, China
| | - Jun Tang
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 210009, China
| | - Zhenning Wu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 210009, China
| | - Jiapan Luan
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 210009, China
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