A Simple and Effective Physical Ball-Milling Strategy to Prepare Super-Tough and Stretchable PVA@MXene@PPy Hydrogel for Flexible Capacitive Electronics

Biomimetic flexible electronics for E-skin have received increasing attention, due to their ability to sense various movements. However, the development of smart skin-mimic material remains a challenge. Here, a simple and effective approach is reported to fabricate super-tough, stretchable, and self-healing conductive hydrogel consisting of polyvinyl alcohol (PVA), Ti3 C2 Tx MXene nanosheets, and polypyrrole (PPy) (PMP hydrogel). The MXene nanosheets and Fe3+ serve as multifunctional cross-linkers and effective stress transfer centers, to facilitate a considerable high conductivity, super toughness, and ultra-high stretchability (elongation up to 4300%) for the PMP hydrogel with. The hydrogels also exhibit rapid self-healing and repeatable self-adhesive capacity because of the presence of dynamic borate ester bond. The flexible capacitive strain sensor made by PMP hydrogel shows a relatively broad range of strain sensing (up to 400%), with a self-healing feature. The sensor can precisely monitor various human physiological signals, including joint movements, facial expressions, and pulse waves. The PMP hydrogel-based supercapacitor is demonstrated with a high capacitance retention of ≈92.83% and a coulombic efficiency of ≈100%.

A Novel Multifunctional Crosslinking PVA/CMCS Hydrogel Containing Cyclic Peptide Actinomycin X2 and PA@Fe with Excellent Antibacterial and Commendable Mechanical Properties

Bacterial infected environments and resulting bacterial infections have been threatening the human health globally. Due to increased bacterial resistance caused by improper and excessive use of antibiotics, antibacterial biomaterials are being developed as alternatives to antibiotics in some cases. Herein, an advanced multifunctional hydrogel with excellent antibacterial properties, enhanced mechanical properties, biocompatibility and self-healing performance, was designed through freezing-thawing method. This hydrogel network is composed of polyvinyl alcohol (PVA), carboxymethyl chitosan (CMCS), protocatechualdehyde (PA), ferric iron (Fe) and an antimicrobial cyclic peptide actinomycin X2 (Ac.X2). The double dynamic bonds among protocatechualdehyde (PA), ferric iron (Fe) and carboxymethyl chitosan containing coordinate bond (catechol-Fe) as well as dynamic Schiff base bonds and hydrogen bonds endowed the hydrogel with enhanced mechanical properties. Successful formation of hydrogel was confirmed through ATR-IR and XRD, and structural evaluation through SEM analysis, whereas mechanical properties were tested with electromechanical universal testing machine. The resulting PVA/CMCS/Ac.X2/PA@Fe (PCXPA) hydrogel has favorable biocompatibility and excellent broad-spectrum antimicrobial activity against both S. aureus (95.3 %) and E. coli (90.2 %) compared with free-soluble Ac.X2, which exhibited subpar performance against E. coli reported in our previous studies. This work provides a new insight on preparing multifunctional hydrogels containing antimicrobial peptides as antibacterial material.

Preparation of polyvinyl alcohol hydrogel containing chlorogenic acid microspheres and its evaluation for use in skin wound healing

Chlorogenic acid (CGA) is a phenolic compound widely found in plants. Several studies have shown that CGA possesses antioxidant, antibacterial, anti-inflammatory and wound healing properties. Because of their three-dimensional structure, good permeability, excellent biocompatibility and moisturizing properties, hydrogels are ideal candidates for wound dressing. The aim of the present study was to preparation and characterization of Polyvinyl alcohol (PVA) hydrogel containing CGA microspheres and evaluation its wound healing activity. The double-emulsion solvent evaporation technique was applied for preparing the CGA containing microspheres. The microspheres were characterized using scanning electron microscopy (SEM) and Fourier transformation infrared spectroscopy (FTIR) and subsequently incorporated in the structure of a PVA hydrogel. The effects of prepared hydrogel on NIH3T3 cell line viability were evaluated using MTT method and wound healing activity was investigated in full thickness wound model in rabbit. SEM images showed formation of homogenous CGA microspheres with diameters in the range of 1-2 μm, embedded in the porous structure of the hydrogel. Infra-red results indicated successful incorporation of CGA microspheres into PVA hydrogel. The NIH3T3 cell viability percentage in CGA 2.5% hydrogel treated group significantly (p < .05) increased after 24 h and 48 h comparing to control group. In vivo studies showed that CGA hydrogel significantly (p < .001) stimulated the rate of wounds closures. Histological studies revealed that administration of CGA hydrogel significantly increased epithelialization and production of collagen fibers compared to the control group. It can be concluded that the CGA microsphere loaded PVA hydrogel has the potential for wound healing.

Modification of Frictional Properties of Hydrogel Surface via Laser Ablated Topographical Micro-Textures

Hydrogels and biological cartilage tissues are highly similar in structure and composition due to their unique characteristics such as high-water content and low friction coefficients. The introduction of hydrogel cartilage can effectively reduce the friction coefficient and wear coefficient of the original bone joint and the implanted metal bone joint (generally titanium alloy or stainless steel), which is considered as a perfect replacement material for artificial articular cartilage. How to accurately regulate the local tribological characteristics of hydrogel artificial cartilage according to patient weight and bone shape is one of the important challenges in the current clinical application field of medical hydrogels. In this study, the mechanism by which micro-pits improve the surface friction properties was studied. Ultraviolet lasers were used to efficiently construct micro-pits with different shapes on a polyvinyl alcohol hydrogel in one step. It was shown that by using such a maskless laser processing, the performance of each part of the artificial cartilage can be customized flexibly and effectively. We envision that the approach demonstrated in this article will provide an important idea for the development of a high-performance, continuous and accurate method for controlling surface friction properties of artificial cartilage.

Early Failure of a Polyvinyl Alcohol Hydrogel Implant With Osteolysis and Foreign Body Reactions in an Ovine Model of Cartilage Repair

BACKGROUND

Hemiarthroplasty using a polyvinyl alcohol (PVA) hydrogel synthetic implant has been suggested as a good alternative to arthrodesis for the treatment of hallux rigidus. However, failure rates as high as 20% have been recorded.

PURPOSE

To characterize the pathological processes in bone, cartilage, and the synovial membrane after PVA hemiarthroplasty in an ovine model with 6 months of follow-up.

STUDY DESIGN

Controlled laboratory study.

METHODS

A unilateral osteochondral defect (8-mm diameter × 10-mm depth) was made in the medial femoral condyle in 6 sheep. Animals were randomized to receive a PVA implant (n = 4) or to have an empty defect (n = 2) and were monitored for 6 months. Patellofemoral radiographs were obtained at monthly intervals, and quantitative computed tomography was performed at the end of the study. After death, the joints were macroscopically evaluated and scored. Osteochondral and synovial membrane histological findings were assessed using modified Osteoarthritis Research Society International (OARSI) and aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) scoring systems. Immunohistochemistry using Iba1 was performed to evaluate activated macrophage infiltration.

RESULTS

Overall, 2 sheep with PVA implants were euthanized at 1 and 5 months because of uncontrollable pain and lameness (failed implants). Quantitative computed tomography showed that sheep with failed implants had 2.1-fold more osteolysis than those with successful implants. The sheep with failed implants had osteoarthritis with extensive glycosaminoglycan loss and cartilage fibrillation of the condyle and opposing tibial surface on histological examination. A foreign body reaction with severe chronic lymphoplasmacytic and granulomatous inflammation with giant cells was detected surrounding the implant. The synovial membrane ALVAL score was 9 of 19 and 14 of 19 in failed implants with synovial hyperplasia and lymphoplasmacytic and macrophage infiltration. In contrast, the synovial membrane in successful implants and empty defects was normal (ALVAL score = 0/19). Immunolabeling for Iba1 in failed implants confirmed extensive and dense macrophage infiltration within the condyle and synovial membrane, with the highest immunoreactive score (9/9).

CONCLUSION

PVA hydrogel implants had a 50% failure rate with uncontrollable pain, severe osteolysis, inflammation, and foreign body reactions.

CLINICAL RELEVANCE

The failure rate and pathological characteristics of the PVA implants suggest that their use should not be continued in human patients without further in vivo safety studies.

Triborheological Study under Physiological Conditions of PVA Hydrogel/HA Lubricant as Synthetic System for Soft Tissue Replacement

In soft tissue replacement, hydrophilic, flexible, and biocompatible materials are used to reduce wear and coefficient of friction. This study aims to develop and evaluate a solid/liquid triborheological system, polyvinyl alcohol (PVA)/hyaluronic acid (HA), to mimic conditions in human synovial joints. Hydrogel specimens prepared via the freeze–thawing technique from a 10% (w/v) PVA aqueous solution were cut into disc shapes (5 ± 0.5 mm thickness). Compression tests of PVA hydrogels presented a Young’s modulus of 2.26 ± 0.52 MPa. Friction tests were performed on a Discovery Hybrid Rheometer DHR-3 under physiological conditions using 4 mg/mL HA solution as lubricant at 37 °C. Contact force was applied between 1 and 20 N, highlighting a coefficient of friction change of 0.11 to 0.31 between lubricated and dry states at 3 N load (angular velocity: 40 rad/s). Thermal behavior was evaluated by differential scanning calorimetry (DSC) in the range of 25–250 °C (5 °C/min rate), showing an endothermic behavior with a melting temperature (Tm) around 231.15 °C. Scanning Electron Microscopy (SEM) tests showed a microporous network that enhanced water content absorption to 82.99 ± 1.5%. Hydrogel achieved solid/liquid lubrication, exhibiting a trapped lubricant pool that supported loads, keeping low coefficient of friction during lubricated tests. In dry tests, interstitial water evaporates continuously without countering sliding movement friction.

Numerically Exploring the Potential of Abating the Energy Flow Peaks through Tough, Single Network Hydrogel Vibration Isolators with Chemical and Physical Cross-Links

Traditional vibration isolation systems, using natural rubber vibration isolators, display large peaks for the energy flow from the machine source and into the receiving foundation, at the unavoidable rigid body resonance frequencies. However, tough, doubly cross-linked, single polymer network hydrogels, with both chemical and physical cross-links, show a high loss factor over a specific frequency range, due to the intensive adhesion-deadhesion activities of the physical cross-links. In this study, vibration isolators, made of this tough hydrogel, are theoretically applied in a realistic vibration isolation system, displaying several rigid body resonances and various energy flow transmission paths. A simulation model is developed, that includes a suitable stress-strain model, and shows a significant reduction of the energy flow peaks. In particular, the reduction is more than 30 times, as compared to the corresponding results using the natural rubber. Finally, it is shown that a significant reduction is possible, also without any optimization of the frequency for the maximum physical loss modulus. This is a clear advantage for polyvinyl alcohol hydrogels, that are somewhat missing the possibility to alter the frequency for the maximum physical loss, due to the physical cross-link system involved-namely, that of the borate esterification.

Preliminary Experience With Polyvinyl Alcohol Hydrogel Implant for Pathology of the Second Metatarsal Head

BACKGROUND

There is no consensus regarding which surgical technique is most beneficial for pathology of the second metatarsophalangeal joint. We report the use of polyvinyl alcohol hydrogel synthetic cartilage implant hemiarthroplasty for pathology of the second metatarsal head that has failed nonoperative treatment and present 5 cases with a minimum 15 months of follow-up.

METHODS

The technique for synthetic cartilage hemiarthroplasty of the second metatarsal head is described. The postoperative protocol included weightbearing as tolerated for 2 weeks and moderate limitations in activities of daily living to respect wound healing, followed by physiotherapy for range of motion exercises. Charts for patients who underwent this procedure between 2015 and 2017 were retrospectively reviewed. Outcome measures collected postoperatively included a pain visual analog scale, Short-Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) current level of function percentages.

RESULTS

At 15 to 38 months of follow-up, patients reported little to no pain and good range of motion, with no complications. Mean outcome measure scores were 89 for FAAM ADL, 75 for FAAM Sports, 44.4 for SF-36 PCS, and 52.1 for SF-36 MCS.

CONCLUSION

This preliminary study of synthetic cartilage hemiarthroplasty for treatment of joint-destructive conditions of the second metatarsal head demonstrated good outcomes and no complications in 5 cases at a mean 25 months of follow-up. Large prospective cohort studies are needed to prove the efficacy and safety of this new surgical technique for the treatment of pathology of the second metatarsal head.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Novel skin patch combining human fibroblast-derived matrix and ciprofloxacin for infected wound healing

Skin injuries are frequently encountered in daily life, but deep wounds often poorly self-heal and do not recover completely. In this study, we propose a novel skin patch that combines antibiotic, cell-derived extracellular matrix (ECM) and biocompatible polyvinyl alcohol (PVA) hydrogel.

Methods: Decellularized human lung fibroblast-derived matrix (hFDM) was prepared on tissue culture plate (TCP) and PVA solution was then poured onto it. After a freeze-thaw process, PVA was peeled off from TCP along with hFDM tightly anchored to PVA. Subsequently, ciprofloxacin (Cipro)-incorporated PVA/hFDM (PVA/Cipro/hFDM) was fabricated via diffusion-based drug loading.

Results: In vitro analyses of PVA/Cipro/hFDM show little cytotoxicity of ciprofloxacin, stability of hFDM, rich fibronectin in hFDM, and good cell attachment, respectively. In addition, hFDM proved to be beneficial in promoting cell migration of dermal fibroblasts and human umbilical vein endothelial cells (HUVECs) using transwell inserts. The antibacterial drug Cipro was very effective in suppressing colony growth of gram-negative and -positive bacteria as identified via an inhibition zone assay. For animal study, infected wound models in BALB/c mice were prepared and four test groups (control, PVA, PVA/Cipro, PVA/Cipro/hFDM) were administered separately and their effect on wound healing was examined for up to 21 days. The results support that Cipro successfully reduced bacterial infection and thus encouraged faster wound closure. Further analysis using histology and immunofluorescence revealed that the most advanced skin regeneration was achieved with PVA/Cipro/hFDM, as assessed via re-epithelialization, collagen texture and distribution in the epidermis, and skin adnexa (i.e., glands and hair follicles) regeneration in the dermis.

Conclusion: This work demonstrates that our skin patch successfully consolidates the regenerative potential of ECM and the antibacterial activity of Cipro for advanced wound healing.

Anterior spinal instrumentation combining a prosthetic disc nucleus with a flexible stabilization device: Manufacture and use in intervertebral disc repair

Artificial disc replacement alone is unable to completely cure cervical degenerative diseases; thus, a stabilization device markedly improves patient recovery. In order to meet this requirement, an anterior spinal instrumentation combining a prosthetic disc nucleus with a flexible stabilization device (ASI combining PDN/FD) was developed. An artificial disc was designed and manufactured using polyvinyl alcohol hydrogel (PVA-H) with a repeated freeze-melting technique, and subsequently the dehydration and swelling properties of the PVA-H were investigated. A canine animal model was then used to compare the differences in the degeneration of cervical discs adjacent to the operative segment with PDN/FD against a plate fixation system, without the interferences of brace intensity, which was ensured by pressure monitoring the dog's intervertebral disc adjacent to operative segments. The in vivo results demonstrated a clear decrease in the degeneration of the adjacent disc with the use of PDN/FD as compared with the plate fixation system. In conclusion, PDN/FD may offer a promising method for the treatment of cervical degenerative disease.

In vitro and in vivo evaluation of blood coagulation activation of polyvinyl alcohol hydrogel plus dextran-based vascular grafts

Polyvinyl alcohol hydrogel (PVA) is a water-soluble synthetic polymer that is commonly used in biomedical applications including vascular grafting. It was argued that the copolymerization of PVA with dextran (Dx) can result in improvement of blood-biomaterial interactions. The focus of this experimental study was to assess that interaction through an in vivo and in vitro evaluation of the coagulation system activation. The thrombogenicity of the copolymer was determined by quantification of platelet adhesion through the lactate dehydrogenase assay, determination of whole blood clotting time, and by quantification of platelet activation by flow cytometry. The thrombin-antithrombin complex blood levels were also determined. The obtained results for the in vitro assays suggested a non-thrombogenic profile for PVA/Dx. Additionally in vivo coagulation and hematological parameters were determined in an animal model after PVA/Dx vascular graft implantation. For coagulation homeostasis assessment, the intrinsic and extrinsic pathway's activation was determined by measuring prothrombin time (PT) and activated partial thromboplastin time (aPTT). Other markers of coagulation and inflammation activation including d-dimers, interleukin-6, and C-reactive protein were also assessed. The PVA/Dx copolymer tended to inhibit platelet adhesion/activation process and the contact activation process for coagulation. These results were also confirmed with the in vivo experiments where the measurements for APTT, interleukin-6, and C-reactive protein parameters were normal considering the species normal range of values. The response to those events is an indicator of the in vitro and in vivo hemocompatibility of PVA/Dx and it allows us to select this biomaterial for further preclinical trials in vascular reconstruction.

Biocompatibility and hemocompatibility of polyvinyl alcohol hydrogel used for vascular grafting--In vitro and in vivo studies

Polyvinyl alcohol hydrogel (PVA) is a synthetic polymer with an increasing application in the biomedical field that can potentially be used for vascular grafting. However, the tissue and blood-material interactions of such gels and membranes are unknown in detail. The objectives of this study were to: (a) assess the biocompatibility and (b) hemocompatibility of PVA-based membranes in order to get some insight into its potential use as a vascular graft. PVA was evaluated isolated or in copolymerization with dextran (DX), a biopolymer with known effects in blood coagulation homeostasis. The effects of the mesenchymal stem cells (MSCs) isolated from the umbilical cord Wharton's jelly in the improvement of PVA biocompatibility and in the vascular regeneration were also assessed. The biocompatibility of PVA was evaluated by the implantation of membranes in subcutaneous tissue using an animal model (sheep). Histological samples were assessed and the biological response parameters such as polymorphonuclear neutrophilic leucocytes and macrophage scoring evaluated in the implant/tissue interface by International Standards Office (ISO) Standard 10993-6 (annex E). According to the scoring system based on those parameters, a total value was obtained for each animal and for each experimental group. The in vitro hemocompatibility studies included the classic hemolysis assay and both human and sheep bloods were used. Relatively to biocompatibility results, PVA was slightly irritant to the surrounding tissues; PVA-DX or PVA plus MSCs groups presented the lowest score according to ISO Standard 10993-6. Also, PVA was considered a nonhemolytic biomaterial, presenting the lowest values for hemolysis when associated to DX.

Poly (epsilon-caprolactone) nanofibrous ring surrounding a polyvinyl alcohol hydrogel for the development of a biocompatible two-part artificial cornea

The study aimed to fabricate and characterize a 2-part artificial cornea as a substitute for penetrating keratoplasty in patients with corneal blindness. The peripheral part of the artificial cornea consisted of plasma-treated electrospun poly (ɛ-caprolactone) (PCL) nanofibers, which were attached to a hydrogel disc of polyvinyl alcohol (PVA) as a central optical part. The physical properties of the prepared artificial cornea, including morphology, mechanical properties, light transmittance, and contact angle, were assessed. Cell attachment and proliferation studies were performed on rabbit limbal stem cells. The SEM image of the polymeric system showed that the peripheral part formed a highly porous scaffold that could facilitate tissue biointegration. Assessment of the mechanical properties of the peripheral nanofibrous part and the hydrogel optical part showed suitable elasticity. Young's modulus values of the electrospun PCL skirt and PVA hydrogel core were 7.5 and 5.3 MPa, respectively, which is in line with the elasticity range of natural human cornea (0.3-7 MPa). The light transmittance of the central part was >85% when measured in the 400-800 nm wavelength range. The plasma-treated PCL nanofibrous scaffold promoted limbal stem cell adhesion and proliferation within 10 days. These results confirmed that the polymeric artificial cornea showed suitable physical properties and good biocompatibility and epithelialization ability.

A new polyvinyl alcohol hydrogel vascular model (KEZLEX) for microvascular anastomosis training

BACKGROUND

Microvascular anastomosis is a challenging neurosurgical technique that requires extensive training for one to master it. We developed a new vascular model (KEZLEX, Ono and Co., Ltd., Tokyo, Japan) as a non-animal, realistic tool for practicing microvascular anastomosis under realistic circumstances.

METHODS

The model was manufactured from polyvinyl alcohol hydrogel to provide 1.0-3.0 mm diameter (available for 0.5-mm pitch), 6-8 cm long tubes that have qualitatively similar surface characteristics, visibility, and stiffness to human donor and recipient arteries for various bypass surgeries based on three-dimensional computed tomography/magnetic resonance imaging scanning data reconstruction using visible human data set and vessel casts.

RESULTS

Trainees can acquire basic microsuturing techniques for end-to-end, end-to-side, and side-to-side anastomoses with handling similar to that for real arteries. To practice standard deep bypass techniques under realistic circumstances, the substitute vessel can be fixed to specific locations of a commercially available brain model with pins.

CONCLUSION

Our vascular prosthesis model is simple and easy to set up for repeated practice, and will contribute to facilitate "off-the-job" training by trainees.