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Shen F, Ding J, Wang Y, Yin C, Han Z, Ren X, Li Y, Wang T. Topical hemostatic agents in spinal surgery. Spine J 2024; 24:933-946. [PMID: 38219838 DOI: 10.1016/j.spinee.2024.01.003] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Spinal surgery can be associated with significant intraoperative blood loss which may lead to various complications. As the number of patients undergoing spinal surgery increases over time, accurate and effective hemostasis becomes critically important. Despite various surgical hemostatic techniques, conventional interventions such as compression, suture, ligation, and heat-generating cautery, are not suitable for osseous and epidural venous plexus bleeding during spinal procedures. Therefore, a variety of hemostatic agents have been developed to promote hemostasis. As they differ in terms of mechanism, form, application and potential adverse reactions, it is important to understand the natural features of existing agents. Here we comprehensively review currently available topical hemostatic agents from different sources and summarize their mechanisms of action, applications, and current or potential utilization in spinal surgery. We found hemostatic agents from different sources exert hemostatic actions through different mechanisms. In addition, topical hemostatic agents play various roles in spinal surgery including as hemostatic agent, dura mater repair, drug-carrier, skin closure, and fibrosis prevention. Compressive neurological complications are the most common complications of these hemostatic agents. Therefore, optimal use in spinal environments should match their features, indications, and efficacy with clinical conditions.
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Affiliation(s)
- Feng Shen
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Jian Ding
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Yuelei Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Chuqiang Yin
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Zengshuai Han
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Xianfeng Ren
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Yanhui Li
- School of Mechanical and Electrical Engineering, Qingdao University, No. 308 Ningxia Road, Shibei District, Qingdao, Shandong Province, China
| | - Ting Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China.
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Park JW, Kim TW, Chang CB, Han M, Go JJ, Park BK, Jo WL, Lee YK. Effects of Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty: Meta-Analysis. J Clin Med 2023; 12:6656. [PMID: 37892794 PMCID: PMC10607432 DOI: 10.3390/jcm12206656] [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: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The effectiveness of Floseal, a thrombin-based hemostatic matrix, in total knee arthroplasty (TKA) in minimizing blood loss and transfusion requirements remains a topic of debate. This meta-analysis aims to evaluate the up-to-date randomized controlled trials (RCTs) on the efficacy and safety of Floseal in TKA. A comprehensive search was conducted in electronic databases to identify relevant RCTs. The methodological quality of the included studies was assessed, and data extraction was performed. The pooled effect sizes were calculated using standardized mean difference (SMD) or odds ratios (OR) with 95% confidence intervals (CIs). Eight studies involving 904 patients were included in the meta-analysis. The use of a thrombin-based hemostatic agent significantly reduced hemoglobin decline (SMD = -0.49, 95% CI: -0.92 to -0.07) and the risk of allogenic transfusion (OR = 0.45, 95% CI: 0.25 to 0.81) but showed no significant difference in the volume of drainage or total blood loss. Funnel plots showed no evidence of publication bias. This meta-analysis provides robust evidence supporting the effectiveness of Floseal in reducing hemoglobin decline and transfusion in TKA. Further well-designed RCTs with longer follow-up periods are warranted to assess long-term efficacy and safety.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Minji Han
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jong Jin Go
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
| | - Byung Kyu Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
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Hu XM, Wang CC, Xiao Y, Jiang P, Liu Y, Qi ZQ. Enhanced wound healing and hemostasis with exosome-loaded gelatin sponges from human umbilical cord mesenchymal stem cells. World J Stem Cells 2023; 15:947-959. [PMID: 37900941 PMCID: PMC10600743 DOI: 10.4252/wjsc.v15.i9.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Rapid wound healing remains a pressing clinical challenge, necessitating studies to hasten this process. A promising approach involves the utilization of human umbilical cord mesenchymal stem cells (hUC-MSCs) derived exosomes. The hypothesis of this study was that these exosomes, when loaded onto a gelatin sponge, a common hemostatic material, would enhance hemostasis and accelerate wound healing. AIM To investigate the hemostatic and wound healing efficacy of gelatin sponges loaded with hUC-MSCs-derived exosomes. METHODS Ultracentrifugation was used to extract exosomes from hUC-MSCs. Nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and western blot techniques were used to validate the exosomes. In vitro experiments were performed using L929 cells to evaluate the cytotoxicity of the exosomes and their impact on cell growth and survival. New Zealand rabbits were used for skin irritation experiments to assess whether they caused adverse skin reactions. Hemolysis test was conducted using a 2% rabbit red blood cell suspension to detect whether they caused hemolysis. Moreover, in vivo experiments were carried out by implanting a gelatin sponge loaded with exosomes subcutaneously in Sprague-Dawley (SD) rats to perform biocompatibility tests. In addition, coagulation index test was conducted to evaluate their impact on blood coagulation. Meanwhile, SD rat liver defect hemostasis model and full-thickness skin defect model were used to study whether the gelatin sponge loaded with exosomes effectively stopped bleeding and promoted wound healing. RESULTS The NTA, TEM, and western blot experimental results confirmed that exosomes were successfully isolated from hUC-MSCs. The gelatin sponge loaded with exosomes did not exhibit significant cell toxicity, skin irritation, or hemolysis, and they demonstrated good compatibility in SD rats. Additionally, the effectiveness of the gelatin sponge loaded with exosomes in hemostasis and wound healing was validated. The results of the coagulation index experiment indicated that the gelatin sponge loaded with exosomes had significantly better coagulation effect compared to the regular gelatin sponge, and they showed excellent hemostatic performance in a liver defect hemostasis model. Finally, the full-thickness skin defect healing experiment results showed significant improvement in the healing process of wounds treated with the gelatin sponge loaded with exosomes compared to other groups. CONCLUSION Collectively, the gelatin sponge loaded with hUC-MSCs-derived exosomes is safe and efficacious for promoting hemostasis and accelerating wound healing, warranting further clinical application.
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Affiliation(s)
- Xin-Mei Hu
- Medical College, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China
| | - Can-Can Wang
- Medical College, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China
| | - Yu Xiao
- Medical College, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China
| | - Peng Jiang
- Medical College, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China
| | - Yu Liu
- Medical College, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China
| | - Zhong-Quan Qi
- Medical College, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China.
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Bozkurt I, Kazanci A, Gurcan O, Gurcay AG, Arikok AT, Bavbek M. Spinal epidural fibrosis following hemostatic agent employment. Br J Neurosurg 2023; 37:137-141. [PMID: 36939282 DOI: 10.1080/02688697.2021.1950627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Failed Back Surgery Syndrome (FBSS) refers to a subset of patients who have new or persistent pain after spinal surgery for back or leg pain. Epidural fibrosis (EF) is a common cause of FBSS. Many agents aiming to prevent EF have been tested. However, hemostatic agents are readily available at hospitals, easy to reach and frequently used. For these reasons, oxidized regenerated cellulose, polysaccharide hemostat, hemostatic thrombin-gelatin matrix and chitosan linear polymer were evaluated for their effects on epidural fibrosis on rats after laminectomy. METHODS 40 Sprague-Dawley rats were randomly divided into 5 equal groups including the control group where only the laminectomy was performed. The other 4 groups received hemostatic agents after laminectomy. The rats were euthanized 45 days later and were assessed by a blinded observer to grade the fibrosis level. RESULTS The study revealed that oxidized regenerated cellulose, polysaccharide hemostat and hemostatic thrombin-gelatin matrix lowered the epidural fibrosis grade which was statistically significant (p < 0.001). Although chitosan linear polymer created fibrosis similar to the control group it was not proven to be statistically significant (p = 0.8999). However, when compared with other hemostatic agents it resulted in a higher fibrosis grade (p < 0.001). CONCLUSION The results obtained from this experimental study revealed that Pahacel, Sealfoam and Surgiflo, were effective in reducing epidural fibrosis after laminectomy in rats.
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Affiliation(s)
- Ismail Bozkurt
- Clinic of Neurosurgery, Cankiri State Hospital, Cankiri, Turkey
| | - Atilla Kazanci
- Department of Neurosurgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Oktay Gurcan
- Clinic of Neurosurgery, Ankara City Hospital, Ankara, Turkey
| | - Ahmet G Gurcay
- Department of Neurosurgery, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ata T Arikok
- Department of Pathology, Ankara Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey
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Gelatin-based hemostatic agents for medical and dental application at a glance: A narrative literature review. Saudi Dent J 2022; 34:699-707. [PMID: 36570577 PMCID: PMC9767835 DOI: 10.1016/j.sdentj.2022.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Uncontrolled bleeding is linked to higher treatment costs, risk of post-surgical infection and increased disease and death. Hemostatic agents are used to treat excessive bleeding. A good hemostatic agent controls bleeding effectively, reduces the need for blood transfusion, removes the need for systemic drugs to control bleeding, results in shorter surgery time, and reduces the cost and length of hospital stay of the patient. Gelatin-based hemostatic agents have been widely used in medical and dental procedures, owing to their biodegradability and biocompatibility, as well as availability and low cost of raw materials. In this narrative literature review, we discuss the background and different types of gelatin-based hemostatic agents in medical and dental procedures, the comparison of gelatin-based and non-gelatin-based hemostatic agents, and the usage and development of enhanced or novel gelatin-based hemostatic agents. Gelatin-based hemostatic agents are effective and important part of bleeding control, as evidenced by its wide application in medicine and dentistry. The development of novel combination gelatin-based hemostatic agents has much potential for effective control of excessive bleeding.
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Sabab A, Vreugde S, Jukes A, Wormald PJ. The potential of chitosan-based haemostats for use in neurosurgical setting - Literature review. J Clin Neurosci 2021; 94:128-134. [PMID: 34863426 DOI: 10.1016/j.jocn.2021.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Abstract
Haemorrhage is a major nuance in neurosurgery since blood can distort the surgeon's field of view and increase the risk of post-operative complications. Currently a variety of commercially available haemostats have been approved for use in neurosurgery, but they have caveats to their use in the brain, including, localised tissue compression, neural toxicity, induce immune reaction or form thrombus within the vessel. Thus, there is a need for haemostats that are efficacious and safe for application on brain and spinal tissue. Chitosan is a naturally occurring bio-polymer that is found on the exoskeleton of arthropods and the cell wall of fungi. Chitosan has been shown to accelerate haemostasis through a myriad of physiological pathways. These findings have led to the development of multiple chitosan-based haemostats, for use in peripheral human tissue. Although, clinical data regarding the use of chitosan-based haemostats in the brain is lacking, a range on in vivo studies have proven chitosan to be efficacious and safe in managing neurosurgical bleeds. Similarly, literature comparing chitosan-based haemostats with commercial haemostats used commonly in neurosurgery, have all demonstrated chitosan to be the superior agent. Additionally, clinical trials of chitosan-based haemostat used in peripheral tissue have all demonstrated chitosan to be safe for human use. The marriage of these findings indicates that the safety and superior efficacy of chitosan-based haemostat, makes it a potentially suitable haemostat for use in neurosurgical setting. However, further research pertaining to the clinical use of chitosan-based haemostat within the central nervous system needs to be conducted.
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Affiliation(s)
- Ahad Sabab
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Alistair Jukes
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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Zhou Y, Ma X, Li Z, Wang B. Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization. J Biomater Appl 2020; 35:776-789. [PMID: 32838612 DOI: 10.1177/0885328220950899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An effective and viable hemostatic agent is important for stopping bleeding during surgery. However, it is difficult to achieve hemostasis at uneven or deep bleeding sites using a gelatin sponge. A flowable hemostatic agent has therefore been developed by processing and improving gelatin sponge, to address bleeding under these conditions. In this study, we evaluated the efficacy, safety, and physical and chemical properties of this flowable hemostatic agent in various experiments. We examined its efficacy for stopping bleeding in a rabbit model of liver abrasion in vivo, and compared its efficacy in dynamic coagulation and erythrocyte aggregation tests with gelatin sponge in vitro. We also investigated its safety in rat histocompatibility and acute systemic toxicity tests in mice in vivo, and in hemolysis tests in vitro, to determine if the flowable hemostatic agent induced any pathological reactions or adverse events. In terms of its physical and chemical properties, we analyzed the morphology and chemical bonds of the flowable hemostatic agent by optical and electron microscopy and infrared spectroscopy, and its absorbency and density. The flowable hemostatic agent resulted in a shorter mean bleeding time, less bleeding, greater likelihood of successful hemostasis, and reduced clotting time compared with gelatin sponge. The flowable agent produced some changes in physical morphology, but no pathological changes or undesirable outcomes were detected. This flowable topical hemostatic agent thus provides a safe and more effective hemostatic method than gelatin sponge, and more promising results for intraoperative hemostasis, especially on uneven or deep bleeding surfaces.
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Affiliation(s)
- Yuanxing Zhou
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, China
| | - Xiaochi Ma
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, China
| | - Bo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, China
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Effect of Celox® Powder on Initial Hemostasis After Cardiac Catheterization in Pediatric Patients with Congenital Heart Disease: A Prospective Study. IRANIAN JOURNAL OF PEDIATRICS 2020. [DOI: 10.5812/ijp.95784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ordinary pressure dressing for hemostasis after cardiac catheterization is time consuming and might cause some problems, such as pain or loss of blood, which has to be controlled, particularly in pediatric patient. Using Celox® (chitosan) powder dressing might cause quicker initial hemostasis. Methods: In this prospective study, we assessed Celox® powder among patients in hospitals affiliated with Shiraz University of Medical Sciences, from November 2017 to February 2018. The patients were stratified in two groups. The case group included patients for whom Celox® powder was used along with sterile gauze pressure at the puncture site to achieve hemostasis, and the control group those in whom hemostasis was achieved by standard sterile gauze pressure method. Results: Sixty patients under 16 years of age with congenital heart diseases were evaluated and underwent cardiac catheterization. We stratified the patients in two groups called case (30 patients) and control group (30 patients). Considering both arterial and venous initial hemostasis, in the case group, the minimum and maximum, median and mean coagulation time were less than those in the control group; however, the initial hemostasis was statistically significant only in venipuncture site. Also, the venous coagulation time was shorter among the patients weighing less than 10 kilograms in comparison to those with higher weight. In the case group, using Celox® stirred hemostasis toward the lower percentiles, but based on 50th percentile, the distribution in each group was identical. Conclusions: Celox® powder dressing in children led to reduced coagulation time in venipuncture site, and we might recommend utilizing this type of dressing for venous hemostasis in children after venipuncture.
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Yang C, Yang X, Lan X, Zhang H, Wang M, Zhang Y, Xu Y, Zhen P. [Structure and mechanical characteristics of spinal dura mater in different segments of sheep's spine]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:232-238. [PMID: 30739422 DOI: 10.7507/1002-1892.201807085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective To clarify the structure and biomechanical characteristics of the dura mater of the cervical, thoracic, and lumbar segments of sheep, in order to provide a theoretical reference for the study of artificial dura mater. Methods Five adult male white sheep were sacrificed. The dura mater of C 5, T 10, and L 3 planes were obtained. The histological HE staining was used to observe the internal structure and the thickness of dura mater; the inner and outer surfaces morphology of the dura was observed by scanning electron microscopy (SEM); transmission electron microscopy (TEM) was used to observe the internal structure of dura mater and to measure the diameter of collagen fibers in each part of dura mater. The dura mater of C 6, C 7, T 11, T 12, L 4, and L 5 planes were taken for uniaxial biomechanical test, and modulus of elasticity, tensile strength, and elongation at break were measured. Results HE staining showed that the thickness of the cervical, thoracic, and lumbar dura mater gradually decreased, and the thickness of the dura mater was (268.19±15.91), (198.16±27.25), (103.74±21.54) μm, respectively, and the differences were significant ( P<0.05). SEM observation showed that there were more collagen fibers and fewer cells on the inner surface of the dura mater, while more cells were distributed on the outer surface, and the cells on the inner and outer surface were stretched along the longitudinal axis. TEM observation showed that the collagen fibers in the dura mater were interlaced and arranged in layers. The collagen fibers in the lamina were arranged in the same direction, and the collagen fibers between the lamina were arranged vertically. The diameters of collagen fibers in the cervical, thoracic, and lumbar dura mater were (68.04±21.00), (64.54±20.64), (60.36±19.65) nm, respectively, and the differences were not significant ( P>0.05). Uniaxial biomechanical tests results showed that there was no significant difference in modulus of elasticity, tensile strength, and elongation at break between the axial and transverse dura mater of the cervical dura mater ( P>0.05); the axial data of thoracic and lumbar segments were significantly larger than the transverse data ( P<0.05). The axial modulus of elasticity, tensile strength, and elongation at break of the dura mater of the cervical, thoracic, and lumbar dura mater were significantly different ( P<0.05) from the transverse ones, and showing a decreasing trend. Among them, the ratio of axial and transverse modulus of elasticity of cervical and thoracic dura were significantly smaller than that of lumbar segment ( P<0.05), and there was no significant difference between cervical segments and thoracic segments ( P>0.05). Conclusion The thickness of dura mater in sheep decreased gradually from head to tail. There are more collagen fibers and fewer cells on the inner surface of dura mater, while the outer surface of dura mater is covered by cells. The collagen fiberboard layers in the dura mater are arranged alternately, and have obvious anisotropic biomechanical characteristics, and the anisotropic biomechanical characteristics get more significant from the head to the tail.
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Affiliation(s)
- Chengwei Yang
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
| | - Xinle Yang
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
| | - Xu Lan
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050,
| | - Hong Zhang
- Department of Orthopedics, Hubei Maternal and Child Health Hospital, Wuhan Hubei, 430070, P.R.China
| | - Ming Wang
- Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou Gansu, 730000, P.R.China
| | - Yaqiang Zhang
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
| | - Yajie Xu
- Department of Respiratory Medicine, Henan Rong Jun Hospital, Xinxiang Henan, 453000, P.R.China
| | - Ping Zhen
- Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou Gansu, 730050, P.R.China
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Jin H, Liu Z, Li W, Jiang Z, Li Y, Zhang B. Polyethylenimine-alginate nanocomposites based bone morphogenetic protein 2 gene-activated matrix for alveolar bone regeneration. RSC Adv 2019; 9:26598-26608. [PMID: 35528551 PMCID: PMC9070436 DOI: 10.1039/c9ra05164c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022] Open
Abstract
The repair and treatment of lost or damaged alveolar bone is of great significance in dentistry. Gene-activated matrix (GAM) technology provides a new way for bone regeneration. It is a local gene delivery system, which can not only recruit cells, but also influence their fate. For this purpose, we fabricated a bone morphogenetic protein 2 (BMP-2) gene-loaded absorbable gelatin sponge (AGS) and studied its effect on promoting alveolar bone formation and preventing resorption following tooth extraction in rats. In order to obtain better transfection efficiency, polyethylenimine-alginate (PEI-al) nanocomposites were synthesized and used as gene vectors to deliver BMP-2 cDNA plasmids (PEI-al/pBMP-2). The transfection efficiency, BMP-2 protein expression and osteogenic differentiation of the cells were investigated in vitro. In vivo, we established an alveolar bone regeneration model by extracting the rats' left mandibular incisors. The rats were randomly assigned into 3 groups: control group, unfilled sockets; AGS group, sockets filled with PEI-al solution-loaded gelatin sponges; AGS/BMP group, sockets filled with PEI-al/pBMP-2 solution-loaded gelatin sponge. Radiological and histological assays were performed at 4 and 8 weeks later. In vitro transfection assays indicated that PEI-al/pBMP-2 complexes could effectively transfect MC3T3-E1 cells, promoting the secretion of BMP-2 protein for at least 14 days, as well as increasing the expression of osteogenesis-related gene, ALP activity and calcium deposition. In vivo, western blot analysis showed BMP-2 protein was expressed in bone tissues of AGS/BMP group. The relative height of the residual alveolar ridge and bone mineral density (BMD) of the AGS/BMP group were significantly greater than those in the AGS and control groups at 4 and 8 weeks, respectively. Histological examination showed that, at 4 weeks, osteoblasts had grown in a cubic shape around the new bone in the AGS/BMP group, suggesting new bone formation. In conclusion, the combination of PEI-al/pBMP-2 complexes and gelatin sponge could promote alveolar bone regeneration, which may provide an easy and valuable method for alveolar ridge preservation and augmentation. Polyethylenimine-alginate nanocomposites based bone morphogenetic protein 2 gene-activated matrix may provide an easy and valuable method for alveolar ridge regeneration.![]()
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Affiliation(s)
- Han Jin
- Institute of Hard Tissue Development and Regeneration
- The Second Affiliated Hospital of Harbin Medical University
- Harbin
- China
- Heilongjiang Academy of Medical Sciences
| | - Zhongshuang Liu
- Institute of Hard Tissue Development and Regeneration
- The Second Affiliated Hospital of Harbin Medical University
- Harbin
- China
- Heilongjiang Academy of Medical Sciences
| | - Wei Li
- Department of Stomatology
- Harbin Children's Hospital
- Harbin
- China
| | - Zhuling Jiang
- Institute of Hard Tissue Development and Regeneration
- The Second Affiliated Hospital of Harbin Medical University
- Harbin
- China
- Department of Implantology
| | - Ying Li
- Institute of Hard Tissue Development and Regeneration
- The Second Affiliated Hospital of Harbin Medical University
- Harbin
- China
- Heilongjiang Academy of Medical Sciences
| | - Bin Zhang
- Institute of Hard Tissue Development and Regeneration
- The Second Affiliated Hospital of Harbin Medical University
- Harbin
- China
- Heilongjiang Academy of Medical Sciences
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