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Liu X, Astudillo Potes MD, Serdiuk V, Dashtdar B, Schreiber AC, Rezaei A, Lee Miller A, Hamouda AM, Shafi M, Elder BD, Lu L. Injectable bioactive poly(propylene fumarate) and polycaprolactone based click chemistry bone cement for spinal fusion in rabbits. J Biomed Mater Res A 2024. [PMID: 38644548 DOI: 10.1002/jbm.a.37725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
Degenerative spinal pathology is a widespread medical issue, and spine fusion surgeries are frequently performed. In this study, we fabricated an injectable bioactive click chemistry polymer cement for use in spinal fusion and bone regrowth. Taking advantages of the bioorthogonal click reaction, this cement can be crosslinked by itself eliminating the addition of a toxic initiator or catalyst, nor any external energy sources like UV light or heat. Furthermore, nano-hydroxyapatite (nHA) and microspheres carrying recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human vascular endothelial growth factor (rhVEGF) were used to make the cement bioactive for vascular induction and osteointegration. After implantation into a rabbit posterolateral spinal fusion (PLF) model, the cement showed excellent induction of new bone formation and bridging bone, achieving results comparable to autograft control. This is largely due to the osteogenic properties of nano-hydroxyapatite (nHA) and the released rhBMP-2 and rhVEGF growth factors. Since the availability of autograft sources is limited in clinical settings, this injectable bioactive click chemistry cement may be a promising alternative for spine fusion applications in addressing various spinal conditions.
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Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria D Astudillo Potes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitalii Serdiuk
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Babak Dashtdar
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Areonna C Schreiber
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Lee Miller
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Thurlapati A, Wesson W, Davis JA, Gaffney KJ, Weeda E, Velayati A, Bakos JK, Granger K, Smith D, Maldonado AP, Herrington T, Potts J, Hashmi H. Impact of Cytogenetic Abnormalities, Induction and Maintenance Regimens on Outcomes After High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Newly Diagnosed Multiple Myeloma: A Decade-Long Real-World Experience. J Hematol 2023; 12:243-254. [PMID: 38188477 PMCID: PMC10769645 DOI: 10.14740/jh1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Abstract
Background High-dose chemotherapy and autologous stem cell transplant (HDT-ASCT) has become a standard of care for transplant eligible newly diagnosed multiple myeloma (NDMM) patients. While cytogenetic abnormalities have been shown to affect outcomes after HDT-ASCT in clinical trials, these trials often exclude or underrepresent elderly patients with comorbidities and those belonging to ethnic minorities. We describe our institutional experience highlighting the impact of high-risk cytogenetic abnormalities (HRCAs) on outcomes after HDT-ASCT for NDMM patients. Methods A total of 449 patients with NDMM who underwent HDT-ASCT between February 2012 and August 2022 were included in this retrospective analysis. HRCAs included the presence of one or more of: deletion 17p, t(14;16), t(4;14), and amplification 1q. Survival analyses, including progression-free survival (PFS) and overall survival (OS), were performed using Kaplan-Meier estimator. Results With a median follow-up of 29 (1 - 128) months for the entire patient population, the best overall response rate for the patients with HRCAs was lower compared to those with standard risk cytogenetics (90% vs. 96%; P = 0.01). Patients with HRCAs had an inferior PFS compared to patients with standard-risk cytogenetics (29 vs. 58 months; P < 0.001) without a difference in OS (70 months vs. not reached; P = 0.13). Conclusions In a multivariable analysis adjusting for factors including age, race, and comorbidities, HRCAs, non-lenalidomide-based maintenance, non-proteasome inhibitor-based maintenance, and age greater than 65 were associated with inferior PFS. Amongst these factors, only non-lenalidomide-based maintenance was associated with inferior OS.
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Affiliation(s)
- Aswani Thurlapati
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
- These authors contributed equally to the creation of the manuscript
| | - William Wesson
- University of Kansas School of Medicine, Kansas City, KS 66103, USA
- These authors contributed equally to the creation of the manuscript
| | - James A. Davis
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Kelly J. Gaffney
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Erin Weeda
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Arash Velayati
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
| | - Jonathan K. Bakos
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
| | - Katelynn Granger
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Deidra Smith
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Andy P. Maldonado
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Taylor Herrington
- Medical University of South Carolina College of Pharmacy, Charleston, SC 29425, USA
| | - Julia Potts
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
| | - Hamza Hashmi
- Department of Hematology and Bone Marrow Transplant, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC 29425, USA
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Waidyaratne G, Bennett C, Umyarova E, Bumma N. Extensive Intracardiac Cement Embolism in a Patient Undergoing Workup for Bone Marrow Transplant. J Hematol 2023; 12:283-286. [PMID: 38188473 PMCID: PMC10769642 DOI: 10.14740/jh1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
Cement emboli are a well-established complication of kyphoplasties and vertebroplasties and can easily be mistaken for wires. While kyphoplasties are commonly performed for vertebral fractures caused by metastases from malignancies such as multiple myeloma, the implication of cement emboli in bone marrow transplant (BMT) patients is not well documented. Our patient presented with an incidental intracardiac cement embolism found while undergoing workup for BMT. He was managed conservatively, but transplant workup was put on hold until the embolism could be removed due to the risks associated with cement emboli. The significance of cement emboli in immunocompromised patients needs to be further investigated.
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Affiliation(s)
- Gavisha Waidyaratne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Caitlin Bennett
- Department of Hospice and Palliative Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Elvira Umyarova
- Division of Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Naresh Bumma
- Division of Hematology and Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Sheng X, Li C, Wang Z, Xu Y, Sun Y, Zhang W, Liu H, Wang J. Advanced applications of strontium-containing biomaterials in bone tissue engineering. Mater Today Bio 2023; 20:100636. [PMID: 37441138 PMCID: PMC10333686 DOI: 10.1016/j.mtbio.2023.100636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 07/15/2023] Open
Abstract
Strontium (Sr) and strontium ranelate (SR) are commonly used therapeutic drugs for patients suffering from osteoporosis. Researches have showed that Sr can significantly improve the biological activity and physicochemical properties of materials in vitro and in vivo. Therefore, a large number of strontium containing biomaterials have been developed for repairing bone defects and promoting osseointegration. In this review, we provide a comprehensive overview of Sr-containing biomaterials along with the current state of their clinical use. For this purpose, the different types of biomaterials including calcium phosphate, bioactive glass, and polymers are discussed and provided future outlook on the fabrication of the next-generation multifunctional and smart biomaterials.
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He Y, Tang X, Liao Y, Liu S, Li L, Li P. The Comparison between Cemented and Uncemented Hemiarthroplasty in Patients with Femoral Neck Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop Surg 2023. [PMID: 37154088 DOI: 10.1111/os.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Hemiarthroplasty is the standard treatment for patients with femoral neck fractures (FNFs). Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. OBJECTIVE We performed an updated systematic review and meta-analysis to compare cemented and uncemented hemiarthroplasty in patients with femoral neck fractures. METHODS A literature review was conducted using Cochrane Library, ScienceDirect, PubMed, Embase, Medline, Web of Science, CNKI, VIP, Wang Fang, and Sino Med databases. Studies comparing cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to June 2022 were included. Data were extracted, meta-analyzed, and pooled as risk ratios (RRs) and weighted mean differences (WMDs) with a 95% confidence interval (95% CI). RESULTS Twenty-four RCTs involving 3471 patients (1749 cement; 1722 uncemented) were analyzed. Patients with cemented intervention had better outcomes regarding hip function, pain, and complications. Significant differences were found in terms of HHS at 6 weeks (WMD 12.5; 95% CI 6.0-17.0; P < 0.001), 3 months (WMD 3.3; 95% CI 1.6-5.0; P < 0.001), 4 months (WMD 7.3; 95% CI 3.4-11.2; P < 0.001), and 6 months (WMD 4.6; 95% CI 3.3-5.8; P < 0.001) postoperatively. Patients with cemented hemiarthroplasty had lower rates of pain (RR 0.59; 95% CI 0.39-0.9; P = 0.013), prosthetic fracture (RR 0.24; 95% CI 0.16-0.38; P < 0.001), subsidence/loosening (RR 0.29; 95% CI 0.11-0.78; P = 0.014), revisions (RR 0.59; 95% CI 0.40-0.89; P = 0.012), and pressure ulcers (RR 0.43; 95% CI 0.23-0.82; P = 0.01) at the expense of longer surgery time (WMD 7.87; 95% CI 5.71-10.02; P < 0.001). CONCLUSION This meta-analysis demonstrated that patients with cemented hemiarthroplasty had better results in hip function and pain relief and lower complication rates at the expense of prolonged surgery time. Cemented hemiarthroplasty is recommended based on our findings.
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Affiliation(s)
- Yue He
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiumei Tang
- Institute of Hospital Management West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liao
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shihua Liu
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingli Li
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengcheng Li
- West China School of Nursing, Sichuan University / Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Li Y, Wang S, Zhu Z, Chen L, Shi Z, Ye X, Xu W, Li Z. Biomechanical Analysis of Cortical Bone Trajectory Screw Versus Bone Cement Screw for Fixation in Porcine Spinal Low Bone Mass Model. Clin Spine Surg 2023; 36:E145-E152. [PMID: 36180974 PMCID: PMC10150626 DOI: 10.1097/bsd.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A prospective study of in vitro animal. OBJECTION To compare the biomechanics of cortical bone trajectory screw (CBT) and bone cement screw (BC) in an isolated porcine spinal low bone mass model. SUMMARY OF BACKGROUND DATA The choice of spinal fixation in patients with osteoporosis remains controversial. Is CBT better than BC? Research on this issue is lacking. METHODS Ten porcine spines with 3 segments were treated with EDTA decalcification. After 8 weeks, all the models met the criteria of low bone mass. Ten specimens were randomly divided into groups, group was implanted with CBT screw (CBT group) and the other group was implanted with bone cement screw (BC group). The biomechanical material testing machine was used to compare the porcine spine activities of the two groups in flexion, extension, bending, and axial rotation, and then insertional torque, pull-out force, and anti-compression force of the 2 groups were compared. Independent sample t test was used for comparison between groups. RESULTS Ten 3 segments of porcine spine models with low bone mass were established, and the bone mineral density of all models was lower than 0.75 g/cm 2 . There is no difference between the CBT and BC groups in flexion, extension, bending, and axial rotation angle, P >0.05. However, there were significant differences between the 2 groups and the control group, with P <0.01. The 2 groups significantly differed between the insertional torque ( P =0.03) and the screw pull-out force ( P =0.021). The anti-compression forces between the 2 groups have no significant difference between the two groups ( P =0.946). CONCLUSIONS The insertional torque and pull-out force of the CBT were higher than those of the BC in the isolated low bone porcine spine model. The range of motion and anti-compression ability of the model was similar between the 2 fixation methods.
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Affiliation(s)
| | - Silian Wang
- Department of Imaging, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Zhenbiao Zhu
- Department of Orthopaedics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, P.R.China
| | - Liwei Chen
- Department of Imaging, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Zhangpeng Shi
- Shanghai Clinical College, Anhui Medical University, Shanghai
| | | | - Wei Xu
- Department of Orthopedics
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Setty AA, Gimarc DC, Abrahams B, Ho CK. Asymptomatic Intracardiac Cement Embolism Following Kyphoplasty. Cureus 2023; 15:e38735. [PMID: 37292539 PMCID: PMC10247207 DOI: 10.7759/cureus.38735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Cement extravasation can occur during vertebral body augmentation such as kyphoplasty and vertebroplasty with diverse presentation and resultant treatment. The cement can embolize through venous vasculature to the thorax where it poses a potential threat to the cardiovascular and pulmonary systems. A thorough risk-benefit analysis should be conducted to select the appropriate treatment course. We present an asymptomatic case of cement extravasation to the heart and lungs during kyphoplasty.
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Affiliation(s)
- Aakash A Setty
- Radiology, Warren Alpert Medical School of Brown University, Providence, USA
| | - David C Gimarc
- Radiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Barbara Abrahams
- Cardiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Corey K Ho
- Radiology, University of Colorado Anschutz Medical Campus, Aurora, USA
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Borjian S, Borjian MA, Ayati A, Zoroufian A. Right atrial and pulmonary cement embolization following vertebral laminectomy: An incidental finding. Clin Case Rep 2023; 11:e7193. [PMID: 37077726 PMCID: PMC10106928 DOI: 10.1002/ccr3.7193] [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: 10/03/2022] [Revised: 03/03/2023] [Accepted: 04/01/2023] [Indexed: 04/21/2023] Open
Abstract
Right heart cement embolization is a rare but potentially life-threatening complication of vertebroplasty surgeries. Transthoracic echocardiography is the first-line imaging modality for detecting cement particles in cardiac chambers. Anticoagulation treatments or surgical interventions are necessary, depending on the patient's condition.
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Affiliation(s)
- Solmaz Borjian
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Department of Advanced EchocardiographyTehran Heart Center, Tehran University of Medical SciencesTehranIran
| | | | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Arezou Zoroufian
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Department of Advanced EchocardiographyTehran Heart Center, Tehran University of Medical SciencesTehranIran
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Liu X, Gaihre B, Li L, Rezaei A, Tilton M, Elder BD, Lu L. Bioorthogonal "Click Chemistry" Bone Cement with Bioinspired Natural Mimicking Microstructures for Bone Repair. ACS Biomater Sci Eng 2023; 9:1585-1597. [PMID: 36854041 PMCID: PMC10123962 DOI: 10.1021/acsbiomaterials.2c01482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Current bone cement systems often demand free radical or metal-related initiators and/or catalysts for the crosslinking process, which may cause serious toxicity to the human body. In addition, the resultant dense scaffolds may have a prolonged degradation time and are difficult for cells to infiltrate and form new tissue. In this study, we developed a porous "click" organic-inorganic nanohybrid (PO-click-ON) cement that crosslinks via metal-free biorthogonal click chemistry and forms porous structures mimicking the native bone tissue via particulate leaching. Strain-promoted click reaction enables fast and efficient crosslinking of polymer chains with the exclusion of any toxic initiator or catalyst. The resulting PO-click-ON implants supported exceptional in vitro stem cell adhesion and osteogenic differentiation with a large portion of stem cells infiltrated deep into the scaffolds. In vivo study using a rat cranial defect model demonstrated that the PO-click-ON system achieved outstanding cell adsorption, neovascularization, and bone formation. The porous click cement developed in this study serves as a promising platform with multifunctionality for bone and other tissue engineering applications.
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Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Bipin Gaihre
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Linli Li
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Maryam Tilton
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Benjamin D Elder
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905, United States
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, United States
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Chen Y, Caneli G, Xie D. A PMMA bone cement with improved antibacterial function and flexural strength. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2022; 33:1398-1414. [PMID: 35321628 DOI: 10.1080/09205063.2022.2056943] [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: 02/09/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
A novel non-leaching antibacterial bone cement has been developed and evaluated. An antibacterial furanone derivative was synthesized and covalently coated onto the surface of alumina filler particles, followed by mixing into a conventional poly(methyl methacrylate) bone cement. Flexural strength and bacterial viability were used to evaluate the modified cements. Effects of coated antibacterial moiety content, coated alumina filler particle size and loading were investigated. Results showed that almost all the modified cements showed higher flexural strength (up to 10%), flexural modulus (up to 18%), and antibacterial activity (up to 67% to S. aureus and up to 84% to E. coli), as compared to original poly(methyl methacrylate) cement. Increasing antibacterial moiety and filler loading significantly enhanced antibacterial activity. On the other hand, increasing coated filler particle size decreased antibacterial activity. Increasing antibacterial moiety content and particle size did not significantly affect flexural strength and modulus. Increasing filler loading did not significantly affect flexural modulus but reduced flexural strength. Antibacterial agent leaching tests showed that it seems no leachable antibacterial component from the modified experimental cement to the surrounding environment. Within the limitations of this study, the modified poly(methyl methacrylate) bone cement may potentially be developed into a clinically useful bone cement for reducing in-surgical and post-surgical infection.
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Affiliation(s)
- Yong Chen
- Department of Biomedical Engineering, Purdue School of Engineering and Technology, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
- Jinchu University, Hubei, P.R. China
| | - Gulsah Caneli
- Department of Biomedical Engineering, Purdue School of Engineering and Technology, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Dong Xie
- Department of Biomedical Engineering, Purdue School of Engineering and Technology, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
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Kou YH, Zhang DY, Zhang JD, Han N, Yang M. Vertebroplasty with high-viscosity cement versus conventional kyphoplasty for osteoporotic vertebral compression fractures: a meta-analysis. ANZ J Surg 2022; 92:2849-2858. [PMID: 35785463 DOI: 10.1111/ans.17894] [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: 01/25/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate outcomes following percutaneous vertebroplasty with high viscosity cement (PVP-HVC) and percutaneous kyphoplasty (PKP) with normal-viscosity cement in patients with osteoporotic vertebral compression fractures (OVCFs). METHODS Pertinent studies were retrieved by searching five electronic databases up to July 2021. Additional records were identified via hand-searching of related references. Risk ratio (RR) and weighted mean difference (WMD), with their 95% confidence intervals (CIs), were calculated. A trial sequential analysis (TSA) was done for cement leakage. RESULTS Twelve studies, embracing 1050 patients with OVCFs, were included. PVP-HVC was superior to PKP with normal-viscosity cement regarding risk of cement leakage (RR: 0.67, 95% CI: 0.54-0.83, I2 : 45.1%) and operation time (WMD: -11.26, 95% CI: -14.78 to -8.34, I2 : 88.8%). However, TSA revealed that a sufficient level of evidence for leakage reduction may have yet to be reached. PKP groups had a significant decrease in Cobb's angles postoperatively (within 1 month, WMD: 2.68, 95% CI: 1.85-3.48, I2 : 0%; after 1 year, WMD: 2.68, 95% CI: 1.35-4.01, I2 : 0%). There are no significant differences between the two procedures pertaining to injected cement volume, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and risk of adjacent vertebral fractures. CONCLUSION PVP-HVC and PKP with normal-viscosity cement are safe and effective treatments for the management of OVCF, but the former is superior to the latter in terms of procedure time. The potential of PVP-HVC in reducing cement leaks remains to be validated by more well-designed studies.
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Affiliation(s)
- Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, Beijing, China.,Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
| | - Dian-Ying Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, Beijing, China.,Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China.,National Center for Trauma Medicine, Peking University People's Hospital, Beijing, China.,Department of Orthopedics, People's Hospital, Peking University, Qingdao, China
| | - Jin-Dong Zhang
- Department of Orthopedics, People's Hospital, Peking University, Qingdao, China
| | - Na Han
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China.,National Center for Trauma Medicine, Peking University People's Hospital, Beijing, China.,Office of Academic Research, Peking University People's Hospital, Peking University, Beijing, China
| | - Ming Yang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, Beijing, China.,Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
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12
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Shin CS, Kim MW, Go JH, Lee JM, Choi JB. Bone cement embolism penetrating both the aorta and the right atrium after percutaneous vertebroplasty: thermal rather than mechanical injury? JTCVS Tech 2022; 14:43-44. [PMID: 35967203 PMCID: PMC9366871 DOI: 10.1016/j.xjtc.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chung Shik Shin
- Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Min Woo Kim
- Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Jun Hui Go
- Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Jeong Moon Lee
- Department of Cardiothoracic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jong Bum Choi
- Department of Cardiovascular Surgery, Presbyterian Medical Center, Jeonju, Republic of Korea
- Address for reprints: Jong Bum Choi, MD, Department of Cardiovascular Surgery, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju, 54987, Republic of Korea.
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13
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Trongtorsak A, Saad E, Mustafa A, Won KS, Haery C, Hamblin MH, Akbar MS. Incidental detection of an intracardiac cement embolism complicating percutaneous vertebroplasty during cardiac catheterization: A case report. J Cardiol Cases 2022; 26:151-153. [DOI: 10.1016/j.jccase.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
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14
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Major Orthopedic Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Weininger G, Sekar RB, Elefteriades JA. Intracardiac polymethylmethacrylate cement embolism. JTCVS Tech 2021; 10:358-360. [PMID: 34977753 PMCID: PMC8691793 DOI: 10.1016/j.xjtc.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/02/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - John A. Elefteriades
- Address for reprints: John A. Elefteriades, MD, PhD (hon), Aortic Institute at Yale New Haven, 789 Howard Ave, New Haven, CT 06519.
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16
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Yoon JC, Kim SE. Chest Pain From an Unusual Cause: Intracardiac Leaked Bone Cement After Percutaneous Vertebroplasty. J Emerg Med 2021; 61:e120-e122. [PMID: 34511299 DOI: 10.1016/j.jemermed.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/17/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jae Chol Yoon
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea.
| | - So Eun Kim
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Republic of Korea.
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17
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He H, Ren H, Ding Z, Ji M, Chen H, Yan Y. Developing a novel magnesium calcium phosphate/sodium alginate composite cement with high strength and proper self-setting time for bone repair. J Biomater Appl 2021; 36:346-357. [PMID: 34053305 DOI: 10.1177/08853282211021535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this work, novel magnesium calcium phosphate/sodium alginate composite cements were successfully fabricated with a proper setting time (5-24 min) and high compressive strength (91.1 MPa). The physicochemical and biological properties of the cement in vitro were fully characterized. The composite cements could gradually degrade in PBS as the soaking time increase, and the weight loss reached 20.74% by the end of 56th day. The cements could induce the deposition of Ca-P layer in SBF. Cell experiments proved that the extracts of the composite cements can effectively promote the proliferation and differentiation of the mouse bone marrow mesenchymal stem cells (MSCs). These preliminary results indicate that the magnesium calcium phosphate/sodium alginate composite cements could be promising as potential bone repair candidate materials.
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Affiliation(s)
- Haosheng He
- College of Physics, Sichuan University, Chengdu, China
| | - Haohao Ren
- College of Physics, Sichuan University, Chengdu, China
| | - Zhengwen Ding
- College of Physics, Sichuan University, Chengdu, China
| | - Mizhi Ji
- College of Physics, Sichuan University, Chengdu, China
| | - Hong Chen
- College of Physics, Sichuan University, Chengdu, China
| | - Yonggang Yan
- College of Physics, Sichuan University, Chengdu, China
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18
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Li YD, Tsai TT, Niu CC, Lai PL. Cement bridging phenomenon in percutaneous vertebroplasty for adjacent vertebral compression fracture. Sci Rep 2021; 11:10184. [PMID: 33986345 PMCID: PMC8119941 DOI: 10.1038/s41598-021-89412-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
In some cases of vertebroplasty for adjacent fractures, we observed a cement bridging phenomenon, in which the injected cement flowed from the newly fractured vertebra to the previously cement-augmented vertebra through the space between the abutting anterior longitudinal ligament and the vertebral column. The purpose of this retrospective study was to investigate this phenomenon. From January 2012 to December 2014, patients who sustained new-onset adjacent vertebral compression fracture and who were again treated with vertebroplasty were enrolled. We divided the patients into two groups, the bridging group and the nonbridging group, to analyze the difference between them. Results showed that the cement bridging phenomenon occurred in 18 (22.8%) of the 79 patients. Significant differences between the bridging and nonbridging groups were identified in the following 3 imaging features: severe loss of the anterior vertebral body height at the new-onset adjacent vertebra on plain film (odds ratio [OR] = 4.46, p = 0.014), fluid accumulation (OR = 36.27, p < 0.001) and hypointense signaling (OR = 15.67, p < 0.001) around the space anterior to the abutting vertebral bodies and the corresponding intervertebral disc on MRI. After a 2-year follow-up, both the mean value of the focal kyphotic angle and anterior body height ratio were significantly better in the cement bridging group than in the nonbridging group. The cement bridging phenomenon, which has never been reported in the literature, is not rare in clinical practice. This phenomenon was associated with better maintenance of focal kyphotic angle and anterior body height ratio during the 2-year follow-up.
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Affiliation(s)
- Yun-Da Li
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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19
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Jarvers JS, Schleifenbaum S, Pfeifle C, Oefner C, Edel M, von der Höh N, Heyde CE. Comparison of three different screw trajectories in osteoporotic vertebrae: a biomechanical investigation. BMC Musculoskelet Disord 2021; 22:418. [PMID: 33952236 PMCID: PMC8101169 DOI: 10.1186/s12891-021-04254-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/13/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pedicle screw insertion in osteoporotic patients is challenging. Achieving more screw-cortical bone purchase and invasiveness minimization, the cortical bone trajectory and the midline cortical techniques represent alternatives to traditional pedicle screws. This study compares the fatigue behavior and fixation strength of the cement-augmented traditional trajectory (TT), the cortical bone trajectory (CBT), and the midline cortical (MC). METHODS Ten human cadaveric spine specimens (L1 - L5) were examined. The average age was 86.3 ± 7.2 years. CT scans were provided for preoperative planning. CBT and MC were implanted by using the patient-specific 3D-printed placement guide (MySpine®, Medacta International), TT were implanted freehand. All ten cadaveric specimens were randomized to group A (CBT vs. MC) or group B (MC vs. TT). Each screw was loaded for 10,000 cycles. The failure criterion was doubling of the initial screw displacement resulting from the compressive force (60 N) at the first cycle, the stop criterion was a doubling of the initial screw displacement. After dynamic testing, screws were pulled out axially at 5 mm/min to determine their remaining fixation strength. RESULTS The mean pull-out forces did not differ significantly. Concerning the fatigue performance, only one out of ten MC of group A failed prematurely due to loosening after 1500 cycles (L3). Five CBT already loosened during the first 500 cycles. The mean displacement was always lower in the MC. In group B, all TT showed no signs of failure or loosening. Three MC failed already after 26 cycles, 1510 cycles or 2144 cycles. The TT showed always a lower mean displacement. In the subsequent pull-out tests, the remaining mean fixation strength of the MC (449.6 ± 298.9 N) was slightly higher compared to the mean pull-out force of the CBT (401.2 ± 261.4 N). However, MC (714.5 ± 488.0 N) were inferior to TT (990.2 ± 451.9 N). CONCLUSION The current study demonstrated that cement-augmented TT have the best fatigue and pull-out characteristics in osteoporotic lumbar vertebrae, followed by the MC and CBT. MC represent a promising alternative in osteoporotic bone if cement augmentation should be avoided. Using the patient-specific placement guide contributes to the improvement of screws' biomechanical properties.
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Affiliation(s)
- J-S Jarvers
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.
| | - S Schleifenbaum
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - C Pfeifle
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - C Oefner
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - M Edel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - N von der Höh
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - C-E Heyde
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
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20
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Liu X, Gaihre B, George MN, Li Y, Tilton M, Yaszemski MJ, Lu L. 2D phosphorene nanosheets, quantum dots, nanoribbons: synthesis and biomedical applications. Biomater Sci 2021; 9:2768-2803. [PMID: 33620047 PMCID: PMC9009269 DOI: 10.1039/d0bm01972k] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Phosphorene, also known as black phosphorus (BP), is a two-dimensional (2D) material that has gained significant attention in several areas of current research. Its unique properties such as outstanding surface activity, an adjustable bandgap width, favorable on/off current ratios, infrared-light responsiveness, good biocompatibility, and fast biodegradation differentiate this material from other two-dimensional materials. The application of BP in the biomedical field has been rapidly emerging over the past few years. This article aimed to provide a comprehensive review of the recent progress on the unique properties and extensive medical applications for BP in bone, nerve, skin, kidney, cancer, and biosensing related treatment. The details of applications of BP in these fields were summarized and discussed.
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Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bipin Gaihre
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew N George
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Yong Li
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Maryam Tilton
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael J Yaszemski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA. and Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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21
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Kong J, Ma J, Wu Z, Wang H, Peng X, Wang S, Wu C, Song Z, Zhao C, Cui F, Qiu Z. Minimally invasive injectable lumbar interbody fusion with mineralized collagen-modified PMMA bone cement: A new animal model. J Appl Biomater Funct Mater 2021; 18:2280800020903630. [PMID: 32421424 DOI: 10.1177/2280800020903630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study was to develop a feasible and safe animal model for minimally invasive injectable lumbar interbody fusion using a novel biomaterial, mineralized collagen-polymethylmethacrylate bone cement (MC-PMMA), with unilateral pedicle screw fixation in an in vivo goat model. Eight goats (Capra aegagrus hircus) were divided into three groups: MC-PMMA, unmodified commercial-polymethylmethacrylate bone cement (UC-PMMA), and a control group (titanium cage filled with autogenous bone, TC-AB). Each group of goats was treated with minimally invasive lumbar interbody fusion at the L3/L4 and L5/L6 disc spaces (injected for MC-PMMA and UC-PMMA, implanted for TC-AB). The pedicle screws were inserted at the L3, L4, L5, and L6 vertebrae, respectively, and fixed on the left side. The characteristics of osteogenesis and bone growth were assessed at the third and the sixth month, respectively. The methods of evaluation included the survival of each animal, X-ray imaging, and 256-layer spiral computed tomography (256-CT) scanning, imaged with three-dimensional microfocus computed tomography (micro-CT), and histological analysis. The results showed that PMMA bone cement can be extruded smoothly after doping MC, the MC-PMMA integrates better with bone than the UC-PMMA, and all goats recovered after surgery without nerve damage. After 3 and 6 months, the implants were stable. New trabecular bone was observed in the TC-AB group. In the UC-PMMA group a thick fibrous capsule had formed around the implants. The MC-PMMA was observed to have perfect osteogenesis and bone ingrowth to adjacent bone surface. Minimally invasive injectable lumbar interbody fusion using MC-PMMA bone cement was shown to have profound clinical value, and the MC-PMMA showed potential application prospects.
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Affiliation(s)
- Jianjun Kong
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Jianqing Ma
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Zhanyong Wu
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Huiwang Wang
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Xiangping Peng
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Shaofeng Wang
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Chunfu Wu
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China
| | - Zhanfeng Song
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China.,Department of Orthopedic Laboratory, Xingtai Institute of Orthopedics, Hebei, P. R. China
| | - Chaohui Zhao
- Department of Orthopedics, Orthopedic Hospital of Xingtai, Hebei, P. R. China
| | - Fuzhai Cui
- School of Materials Science and Engineering, Tsinghua University, Beijing, P. R. China.,Beijing Allgens Medical Science and Technology Co., Ltd., Beijing, P. R. China
| | - Zhiye Qiu
- School of Materials Science and Engineering, Tsinghua University, Beijing, P. R. China.,Beijing Allgens Medical Science and Technology Co., Ltd., Beijing, P. R. China
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22
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Robo C, Wenner D, Ubhayasekera SJKA, Hilborn J, Öhman-Mägi C, Persson C. Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid. J Funct Biomater 2021; 12:5. [PMID: 33477310 PMCID: PMC7839050 DOI: 10.3390/jfb12010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
Acrylic bone cements modified with linoleic acid are a promising low-modulus alternative to traditional high-modulus bone cements. However, several key properties remain unexplored, including the effect of autoclave sterilization and the potential use of low-modulus cements in other applications than vertebral augmentation. In this work, we evaluate the effect of sterilization on the structure and stability of linoleic acid, as well as in the handling properties, glass transition temperature, mechanical properties, and screw augmentation potential of low-modulus cement containing the fatty acid. Neither 1H NMR nor SFC-MS/MS analysis showed any detectable differences in autoclaved linoleic acid compared to fresh one. The peak polymerization temperature of the low-modulus cement was much lower (28-30 °C) than that of the high-modulus cement (67 °C), whereas the setting time remained comparable (20-25 min). The Tg of the low-modulus cement was lower (75-78 °C) than that of the high-stiffness cement (103 °C). It was shown that sterilization of linoleic acid by autoclaving did not significantly affect the functional properties of low-modulus PMMA bone cement, making the component suitable for sterile production. Ultimately, the low-modulus cement exhibited handling and mechanical properties that more closely match those of osteoporotic vertebral bone with a screw holding capacity of under 2000 N, making it a promising alternative for use in combination with orthopedic hardware in applications where high-stiffness augmentation materials can result in undesired effects.
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Affiliation(s)
- Céline Robo
- Department of Materials Science and Engineering, Division of Applied Materials Science, Uppsala University, 751 21 Uppsala, Sweden; (C.R.); (D.W.); (C.Ö.-M.)
| | - David Wenner
- Department of Materials Science and Engineering, Division of Applied Materials Science, Uppsala University, 751 21 Uppsala, Sweden; (C.R.); (D.W.); (C.Ö.-M.)
| | | | - Jöns Hilborn
- Department of Chemistry, Division of Polymer Chemistry, Uppsala University, 751 21 Uppsala, Sweden;
| | - Caroline Öhman-Mägi
- Department of Materials Science and Engineering, Division of Applied Materials Science, Uppsala University, 751 21 Uppsala, Sweden; (C.R.); (D.W.); (C.Ö.-M.)
| | - Cecilia Persson
- Department of Materials Science and Engineering, Division of Applied Materials Science, Uppsala University, 751 21 Uppsala, Sweden; (C.R.); (D.W.); (C.Ö.-M.)
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23
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Developing a biodegradable tricalcium silicate/glucono-delta-lactone/calcium sulfate dihydrate composite cement with high preliminary mechanical property for bone filling. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 119:111621. [PMID: 33321663 DOI: 10.1016/j.msec.2020.111621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
Bone cements with the feature of easily shaping could ideally match the defect site and prevent the ingrowth of fibrous tissue. In this manuscript, a biodegradable tricalcium silicate (C3S)/glucono-delta-lactone (GDL)/calcium sulfate dihydrate (CSD) organic-inorganic composite cement was fabricated with shorter setting time (less than 15 min) and high preliminary mechanical property (5.27 MPa in the first hour). Many methods were applied to study the physicochemical and biological properties of the cement in vitro. The weight loss in PBS can reach 58% after 12 weeks soaking indicating the better biodegradability. The excellent bioactivity in vitro was emerging after the cement was soaked in the simulated body fluid. The cell experiments showed that suitable concentration of the extract liquid of cement was conducive to the proliferation, differentiation and extracellular matrix calcification of the mouse bone marrow stromal cells. Briefly, the C3S/GDL/CSD composite cement would have the bright capacity for bone filling.
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24
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Mathy RM, Kuhn TC, Kappes J, Wielpütz MO, Ruhparwar A, Frankenstein L, Tanner M, Geis N, Fischer C, Kasperk C, Heussel CP, Kreuter M, Wilkens FM. Intracardial PMMA bone cement embolism after kyphoplasty-an unusual cause for sudden chest pain, hemothorax and hemopericardium. Med Klin Intensivmed Notfmed 2020; 116:61-64. [PMID: 32607594 DOI: 10.1007/s00063-020-00698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 07/08/2019] [Accepted: 08/10/2019] [Indexed: 10/24/2022]
Affiliation(s)
- R M Mathy
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - T C Kuhn
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - J Kappes
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - M O Wielpütz
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - A Ruhparwar
- Cardiac Surgery Clinic, University of Heidelberg, Heidelberg, Germany
| | - L Frankenstein
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - M Tanner
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany
| | - N Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - C Fischer
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany
| | - C Kasperk
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - C P Heussel
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - M Kreuter
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - F M Wilkens
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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25
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Hamajima K, Ozawa R, Saruta J, Saita M, Kitajima H, Taleghani SR, Usami D, Goharian D, Uno M, Miyazawa K, Goto S, Tsukinoki K, Ogawa T. The Effect of TBB, as an Initiator, on the Biological Compatibility of PMMA/MMA Bone Cement. Int J Mol Sci 2020; 21:ijms21114016. [PMID: 32512780 PMCID: PMC7312717 DOI: 10.3390/ijms21114016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
Acrylic bone cement is widely used in orthopedic surgery for treating various conditions of the bone and joints. Bone cement consists of methyl methacrylate (MMA), polymethyl methacrylate (PMMA), and benzoyl peroxide (BPO), functioning as a liquid monomer, solid phase, and polymerization initiator, respectively. However, cell and tissue toxicity caused by bone cement has been a concern. This study aimed to determine the effect of tri-n-butyl borane (TBB) as an initiator on the biocompatibility of bone cement. Rat spine bone marrow-derived osteoblasts were cultured on two commercially available PMMA-BPO bone cements and a PMMA-TBB experimental material. After a 24-h incubation, more cells survived on PMMA-TBB than on PMMA-BPO. Cytomorphometry showed that the area of cell spread was greater on PMMA-TBB than on PMMA-BPO. Analysis of alkaline phosphatase activity, gene expression, and matrix mineralization showed that the osteoblastic differentiation was substantially advanced on the PMMA-TBB. Electron spin resonance (ESR) spectroscopy revealed that polymerization radical production within the PMMA-TBB was 1/15–1/20 of that within the PMMA-BPO. Thus, the use of TBB as an initiator, improved the biocompatibility and physicochemical properties of the PMMA-based material.
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Affiliation(s)
- Kosuke Hamajima
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 1-1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan; (K.M.); (S.G.)
| | - Ryotaro Ozawa
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral Interdisciplinary Medicine (Prosthodontics & Oral Implantology), Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan
| | - Juri Saruta
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan;
| | - Makiko Saita
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral Interdisciplinary Medicine (Prosthodontics & Oral Implantology), Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan
| | - Hiroaki Kitajima
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Samira Rahim Taleghani
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
| | - Dan Usami
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
| | - Donya Goharian
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
| | - Mitsunori Uno
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Prosthodontics, Division of Oral Functional Science and Rehabilitation, Asahi University School of Dentistry, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Ken Miyazawa
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 1-1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan; (K.M.); (S.G.)
| | - Shigemi Goto
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 1-1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan; (K.M.); (S.G.)
| | - Keiichi Tsukinoki
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan;
| | - Takahiro Ogawa
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Correspondence: ; Tel.: +1-310-825-0727; Fax: +1-310-825-6345
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Yousefi AM. A review of calcium phosphate cements and acrylic bone cements as injectable materials for bone repair and implant fixation. J Appl Biomater Funct Mater 2020; 17:2280800019872594. [PMID: 31718388 DOI: 10.1177/2280800019872594] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Treatment of bone defects caused by trauma or disease is a major burden on human healthcare systems. Although autologous bone grafts are considered as the gold standard, they are limited in availability and are associated with post-operative complications. Minimally invasive alternatives using injectable bone cements are currently used in certain clinical procedures, such as vertebroplasty and balloon kyphoplasty. Nevertheless, given the high incidence of fractures and pathologies that result in bone voids, there is an unmet need for injectable materials with desired properties for minimally invasive procedures. This paper provides an overview of the most common injectable bone cement materials for clinical use. The emphasis has been placed on calcium phosphate cements and acrylic bone cements, while enabling the readers to compare the opportunities and challenges for these two classes of bone cements. This paper also briefly reviews antibiotic-loaded bone cements used in bone repair and implant fixation, including their efficacy and cost for healthcare systems. A summary of the current challenges and recommendations for future directions has been brought in the concluding section of this paper.
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Affiliation(s)
- Azizeh-Mitra Yousefi
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, USA
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Li C, Sun J, Shi K, Long J, Li L, Lai Y, Qin L. Preparation and evaluation of osteogenic nano-MgO/PMMA bone cement for bone healing in a rat critical size calvarial defect. J Mater Chem B 2020; 8:4575-4586. [PMID: 32242606 DOI: 10.1039/d0tb00074d] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The clinical outcomes of polymethylmethacrylate (PMMA) bone cement used to fill gaps or marrow cavities of bones and bone defects are limited due to poor handling properties, mismatched mechanical properties with natural bone and lack of osteogenesis for bone healing. In this study, a series of PMMA bone cements containing active nano-MgO particles (nano-MgO/PMMA) were prepared. The handling and mechanical properties were systemically evaluated according to an International Standardization Organization standard (ISO 5833:2002). The biocompatibility and osteogenic activity of nano-MgO/PMMA were also analysed in vitro. The osteogenic effects of nano-MgO/PMMA were assessed in a rat calvarial critical bone defect model. The addition of less than 15 wt% nano-MgO to PMMA improved the handling properties of PMMA. Compared with PMMA, the compression modulus and strength of 20MP (20 wt% nano-MgO to PMMA) decreased to 0.725 ± 0.023 GPa and 25.38 ± 2.82 MPa, respectively. In vitro studies with MC3T3-E1 showed that nano-MgO/PMMA had better biocompatibility than the PMMA group after 7 days of culture. The nano-MgO/PMMA groups showed more calcium nodules and higher osteogenic gene expression levels than PMMA after 12 days of osteogenic induction of the rat BMSCs. The in vivo studies analysed by micro-CT and histomorphology results proved that nano-MgO/PMMA could significantly enhance new bone formation. The mean new bone mineral density in the nano-MgO/PMMA group was 50% greater than that in the PMMA group. In addition, biomechanical tests showed that nano-MgO/PMMA was superior to PMMA in bone-bonding strength after 12 weeks implantation. Therefore, the nano-MgO/PMMA bone cement has good potential in joint fixation and bone defect filling applications.
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Affiliation(s)
- Cairong Li
- Centre for Translational Medicine Research & Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
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Novel Osteogenic Behaviors around Hydrophilic and Radical-Free 4-META/MMA-TBB: Implications of an Osseointegrating Bone Cement. Int J Mol Sci 2020; 21:ijms21072405. [PMID: 32244335 PMCID: PMC7177939 DOI: 10.3390/ijms21072405] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 12/15/2022] Open
Abstract
Poly(methyl methacrylate) (PMMA)-based bone cement, which is widely used to affix orthopedic metallic implants, is considered bio-tolerant but lacks osteoconductivity and is cytotoxic. Implant loosening and toxic complications are significant and recognized problems. Here we devised two strategies to improve PMMA-based bone cement: (1) adding 4-methacryloyloxylethyl trimellitate anhydride (4-META) to MMA monomer to render it hydrophilic; and (2) using tri-n-butyl borane (TBB) as a polymerization initiator instead of benzoyl peroxide (BPO) to reduce free radical production. Rat bone marrow-derived osteoblasts were cultured on PMMA-BPO, common bone cement ingredients, and 4-META/MMA-TBB, newly formulated ingredients. After 24 h of incubation, more cells survived on 4-META/MMA-TBB than on PMMA-BPO. The mineralized area was 20-times greater on 4-META/MMA-TBB than PMMA-BPO at the later culture stage and was accompanied by upregulated osteogenic gene expression. The strength of bone-to-cement integration in rat femurs was 4- and 7-times greater for 4-META/MMA-TBB than PMMA-BPO during early- and late-stage healing, respectively. MicroCT and histomorphometric analyses revealed contact osteogenesis exclusively around 4-META/MMA-TBB, with minimal soft tissue interposition. Hydrophilicity of 4-META/MMA-TBB was sustained for 24 h, particularly under wet conditions, whereas PMMA-BPO was hydrophobic immediately after mixing and was unaffected by time or condition. Electron spin resonance (ESR) spectroscopy revealed that the free radical production for 4-META/MMA-TBB was 1/10 to 1/20 that of PMMA-BPO within 24 h, and the substantial difference persisted for at least 10 days. The compromised ability of PMMA-BPO in recruiting cells was substantially alleviated by adding free radical-scavenging amino-acid N-acetyl cysteine (NAC) into the material, whereas adding NAC did not affect the ability of 4-META/MMA-TBB. These results suggest that 4-META/MMA-TBB shows significantly reduced cytotoxicity compared to PMMA-BPO and induces osteoconductivity due to uniquely created hydrophilic and radical-free interface. Further pre-clinical and clinical validations are warranted.
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29
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D'Elia A, Deering J, Clifford A, Lee BEJ, Grandfield K, Zhitomirsky I. Electrophoretic deposition of polymethylmethacrylate and composites for biomedical applications. Colloids Surf B Biointerfaces 2019; 188:110763. [PMID: 31896518 DOI: 10.1016/j.colsurfb.2019.110763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 12/28/2022]
Abstract
For the first time, an electrophoretic deposition (EPD) method has been developed for the deposition of polymethylmethacrylate (PMMA) and PMMA-alumina films for biomedical implant applications. The proposed biomimetic approach was based on the use of a bile salt, sodium cholate (NaCh), which served as a multifunctional solubilizing, charging, dispersing and film-forming agent. Investigations revealed PMMA-Ch- and PMMA-alumina interactions, which facilitated the deposition of PMMA and PMMA-alumina films. This approach allows for the use of a non-toxic water-ethanol solvent for PMMA. The proposed deposition strategy can also be used for co-deposition of PMMA with other functional materials. The PMMA and composite films were tested for biomedical implant applications. The PMMA-alumina films showed statistically improved metabolic results compared to both the bare stainless steel substrate and pure PMMA films. Alkaline phosphatase (ALP) activity affirmed the bioactivity and osteoconductive potential of PMMA and composite films. PMMA-alumina films showed greater ALP activity than both the PMMA-coated and uncoated stainless steel.
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Affiliation(s)
- A D'Elia
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - J Deering
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - A Clifford
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - B E J Lee
- School of Biomedical Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - K Grandfield
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - I Zhitomirsky
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada.
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30
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Leu TH, Wei Y, Hwua YS, Huang XJ, Huang JT, Chung RJ. Fabrication of PLLA/C 3S Composite Membrane for the Prevention of Bone Cement Leakage. Polymers (Basel) 2019; 11:polym11121971. [PMID: 31801199 PMCID: PMC6960822 DOI: 10.3390/polym11121971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/28/2022] Open
Abstract
Kyphoplasty is an important treatment for stabilizing spine fractures due to osteoporosis. However, leakage of polymethyl-methacrylate (PMMA) bone cement during this procedure into the spinal canal has been reported to cause many adverse effects. In this study, we prepared an implantable membrane to serve as a barrier that avoids PMMA cement leakage during kyphoplasty procedures through a hybrid composite made of poly-l-lactic acid (PLLA) and tricalcium silicate (C3S), with the addition of C3S into PLLA matrix, showing enhanced mechanical and anti-degradation properties while keeping good cytocompatibility when compared to PLLA alone and most importantly, when this material design was applied under standardized PMMA cement injection conditions, no posterior wall leakage was observed after the kyphoplasty procedure in pig lumbar vertebral bone models. Testing results assess its effectiveness for clinical practice.
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Affiliation(s)
- Tsai-Hsueh Leu
- Department of Mechanical Engineering, College of Mechanical & Electrical Engineering, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan;
- Department of Orthopedics, Taipei City Hospital, Renai Branch, Taipei 10629, Taiwan
| | - Yang Wei
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.W.); (X.-J.H.)
| | - Yi-Shi Hwua
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan;
| | - Xiao-Juan Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.W.); (X.-J.H.)
| | - Jung-Tang Huang
- Department of Mechanical Engineering, College of Mechanical & Electrical Engineering, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan;
- Correspondence: (J.-T.H.); (R.-J.C.); Tel.: +(886-2)-2771-2171 (ext. 2547) (R.-J.C.)
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan; (Y.W.); (X.-J.H.)
- Correspondence: (J.-T.H.); (R.-J.C.); Tel.: +(886-2)-2771-2171 (ext. 2547) (R.-J.C.)
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31
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Kausar A. Poly(methyl methacrylate) nanocomposite reinforced with graphene, graphene oxide, and graphite: a review. POLYM-PLAST TECH MAT 2019. [DOI: 10.1080/25740881.2018.1563112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ayesha Kausar
- School of Natural Sciences, National University of Sciences and Technology (NUST), Islamabad, Pakistan
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32
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Oshinsky C, Bhavani S, Funaki A. Cement cardiac embolism following kyphoplasty noted on thoracic imaging. Radiol Case Rep 2018; 13:914-916. [PMID: 30069279 PMCID: PMC6068336 DOI: 10.1016/j.radcr.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 12/26/2022] Open
Abstract
Asymptomatic polymethyl methacrylate cardiac embolism is an uncommon complication of kyphoplasty. We report a case of a 56-year-old female with an incidentally noted radiopaque foreign body in the right ventricular cavity on chest x-ray following kyphoplasty. In this report, we discuss how to differentiate between the potential intracardiac foreign bodies and how to establish the diagnosis of polymethyl methacrylate embolism. Once diagnosed, the management of these patients remains controversial.
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Affiliation(s)
- Charles Oshinsky
- University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637, USA
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33
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Fadili Hassani S, Cormier E, Shotar E, Drir M, Spano JP, Morardet L, Collet JP, Chiras J, Clarençon F. Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management. Eur Radiol 2018; 29:663-673. [DOI: 10.1007/s00330-018-5647-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
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Duijvelshoff R, Anthonissen NFM, Morshuis WJ, Van Garsse L. Intracardiac cement embolism resulting in tricuspid regurgitation. Eur J Cardiothorac Surg 2018; 55:366-368. [DOI: 10.1093/ejcts/ezy233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/25/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Renee Duijvelshoff
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Leen Van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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35
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Ding Z, Li H, Wei J, Li R, Yan Y. Developing a novel magnesium glycerophosphate/silicate-based organic-inorganic composite cement for bone repair. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 87:104-111. [DOI: 10.1016/j.msec.2018.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/11/2017] [Accepted: 03/01/2018] [Indexed: 02/06/2023]
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36
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Robo C, Hulsart-Billström G, Nilsson M, Persson C. In vivo response to a low-modulus PMMA bone cement in an ovine model. Acta Biomater 2018; 72:362-370. [PMID: 29559365 DOI: 10.1016/j.actbio.2018.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023]
Abstract
Poly(methyl methacrylate) (PMMA) is the most commonly used material for the treatment of osteoporosis-induced vertebral compression fractures. However, its high stiffness may introduce an increased risk of adjacent vertebral fractures post-surgery. One alternative in overcoming this concern is the use of additives. This presents its own challenge in maintaining an adequate biocompatibility when modifying the base cement. The aim of this study was to evaluate the in vivo biocompatibility of linoleic acid (LA)-modified acrylic bone cement using a large animal model for the first time, in order to further advance towards clinical use. A worst-case approach was used, choosing a slow-setting base cement. The in vitro monomer release from the cements was also assessed. Additional material characterization, including mechanical tests, are summarized in Appendix A. Unmodified and LA-modified cements were injected into a total of 56 bone defects created in the femur and humerus of sheep. Histopathologic and histomorphometric analysis indicated that LA-modified cement showed a harmless tissue response similar to that of the unmodified cement. Adjacent bone remodeling was observed microscopically 4 weeks after implantation, suggesting a normal healing process of the bone tissues surrounding the implant. LA-modified cement exhibited lower mechanical properties, with a reduction in the elastic modulus of up to 65%. The handling properties were slightly modified without negatively affecting the injectability of the base cement. LA-modified bone cement showed good biocompatibility as well as bone compliant mechanical properties and may therefore be a promising material for the treatment of osteoporotic vertebral fractures. STATEMENT OF SIGNIFICANCE The benefits of using linoleic acid to reduce the stiffness of poly(methyl methacrylate) bone cement has been demonstrated previously, with the in vitro and in vivo response of the modified cement in small animals reported as comparable to the base cement. However, biocompatibility evaluation of modified cement in large animal models for future clinical use has yet to be performed. In this study, modified and unmodified cements were injected into bone defects created in sheep. We showed that the inflammatory response of the modified cement was similar to the base cement, allowing remodelling of the bone surrounding the implant. This demonstrates the potential of low-modulus PMMA cement in the field of bone augmentation.
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37
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Robo C, Öhman-Mägi C, Persson C. Compressive fatigue properties of commercially available standard and low-modulus acrylic bone cements intended for vertebroplasty. J Mech Behav Biomed Mater 2018; 82:70-76. [PMID: 29571115 DOI: 10.1016/j.jmbbm.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
Vertebroplasty (VP) is a minimally invasive surgical procedure commonly used to relieve severe back pain associated with vertebral compression fractures. The poly(methyl methacrylate) bone cement used during this procedure is however presumed to facilitate the occurrence of additional fractures next to the treated vertebrae. A reason for this is believed to be the difference in stiffness between the bone cement and the surrounding trabecular bone. The use of bone cements with lower mechanical properties could therefore reduce the risk of complications post-surgery. While intensive research has been performed on the quasi-static mechanical properties of these cements, there is no data on their long-term mechanical properties. In the present study, the in vitro compressive fatigue performance as well as quasi-static mechanical properties of two commercially available acrylic bone cements - a low-modulus cement (Resilience®) and a standard cement (F20) from the same manufacturer - were determined. The quasi-static mechanical properties of the low-modulus and standard cements after 24 h of setting were in the range of other vertebroplastic cements (σ = 70-75 MPa; E= 1600-1900 MPa). F20 displayed similar mechanical properties over time in 37 °C phosphate buffered saline solution, while the mechanical properties of the Resilience® cement decreased gradually due to an increased porosity in the polymeric matrix. The standard cement exhibited a fatigue limit of approx. 47 MPa, whereas the low-modulus cement showed a fatigue limit of approx. 31 MPa. In summary, the low-modulus bone cement had a lower fatigue limit than the standard cement, as expected. However, this fatigue limit is still substantially higher than the stresses experienced by vertebral trabecular bone.
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Affiliation(s)
- Céline Robo
- Materials in Medicine Group, Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Caroline Öhman-Mägi
- Materials in Medicine Group, Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Cecilia Persson
- Materials in Medicine Group, Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden.
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38
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Cui X, Huang C, Zhang M, Ruan C, Peng S, Li L, Liu W, Wang T, Li B, Huang W, Rahaman MN, Lu WW, Pan H. Enhanced osteointegration of poly(methylmethacrylate) bone cements by incorporating strontium-containing borate bioactive glass. J R Soc Interface 2017; 14:20161057. [PMID: 28615491 PMCID: PMC5493788 DOI: 10.1098/rsif.2016.1057] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/23/2017] [Indexed: 11/12/2022] Open
Abstract
Although poly(methylmethacrylate) (PMMA) cements are widely used in orthopaedics, they have numerous drawbacks. This study aimed to improve their bioactivity and osseointegration by incorporating strontium-containing borate bioactive glass (SrBG) as the reinforcement phase and bioactive filler of PMMA cement. The prepared SrBG/PMMA composite cements showed significantly decreased polymerization temperature when compared with PMMA and retained properties of appropriate setting time and high mechanical strength. The bioactivity of SrBG/PMMA composite cements was confirmed in vitro, evidenced by ion release (Ca, P, B and Sr) from SrBG particles. The cellular responses of MC3T3-E1 cells in vitro demonstrated that SrBG incorporation could promote adhesion, migration, proliferation and collagen secretion of cells. Furthermore, our in vivo investigation revealed that SrBG/PMMA composite cements presented better osseointegration than PMMA bone cement. SrBG in the composite cement could stimulate new-bone formation around the interface between the composite cement and host bone at eight and 12 weeks post-implantation, whereas PMMA bone cement only stimulated development of an intervening connective tissue layer. Consequently, the SrBG/PMMA composite cement may be a better alternative to PMMA cement in clinical applications and has promising orthopaedic applications by minimal invasive surgery.
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Affiliation(s)
- Xu Cui
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Chengcheng Huang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Meng Zhang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Changshun Ruan
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Songlin Peng
- Department of Spine Surgery, Shenzhen People's Hospital, Jinan University School of Medicine, Shenzhen 518020, People's Republic of China
| | - Li Li
- The Fourth Affiliated Hospital of Guangxi Medical University/Liu Zhou Worker's Hospital, Liuzhou 545005, People's Republic of China
| | - Wenlong Liu
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Ting Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics, The University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Shenzhen, People's Republic of China
| | - Bing Li
- The Fourth Affiliated Hospital of Guangxi Medical University/Liu Zhou Worker's Hospital, Liuzhou 545005, People's Republic of China
| | - Wenhai Huang
- Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092, People's Republic of China
| | - Mohamed N Rahaman
- Department of Materials Science and Engineering, Center for Biomedical Science and Engineering, Missouri University of Science and Technology, Rolla, MO 65409-0340, USA
| | - William W Lu
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Room 907, Lab Block, 21 Sassoon Road, Hong Kong SAR, People's Republic of China
| | - Haobo Pan
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
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Henderson R. Expert’s comment concerning Grand Rounds case entitled “Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy” by Hatzantonis C, Czyz M, Pyzik R, Boszczyk BM. (Eur Spine J; 2016. doi:10.1007/s00586-016-4695-x). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:3206-3208. [DOI: 10.1007/s00586-017-5089-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
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