Clinical and patient reported outcomes of Vitamin E diffused highly cross-linked polyethylene liner versus moderately cross linked polyethylene liner in total hip arthroplasty: A meta-analysis

Introduction@#In the modern era of Medicine, total hip arthroplasty (THA) is found to last longer than ever before due to the fact that there has been improved bearing surfaces and materials available. Despite these modern approaches, failure caused by polyethylene wear, aseptic loosening, instability and mispositioning and even infection could affect THA survival. In the course of addressing anti-wear characteristics of the conventional polyethylene surface various approaches have been made. To date, there are very limited studies done in which polyethylene liner is better.@*General Objective@#To compare the effects of vitamin E diffused highly cross-linked polyethylene liner versus moderately cross-linked polyethylene liner in THA. @*Methodology@#Meta-analysis research design was used in this study. The primary investigators conducted a comprehensive literature search from Medline, Cochrane Library, PubMed, Elsevier, Google Scholar, Embase and ClinicalTrial.gov as electronic database. All randomized controlled trials comparing the effects of vitamin E diffused highly cross-linked polyethylene liner versus moderately cross-linked polyethylene liner in THA were included in the review. @*Conclusions@#The investigation disclosed no statistical significance between moderately cross-linked polyethylene liner and vitamin E diffused highly cross-linked polyethylene liner in terms of migration, head penetration and wear on mediolateral, longitudinal and anteroposterior axes after 2 and 5 years of undergoing THA. Moreover, the data pertaining to patient reported outcomes and clinical outcomes measure also indicated no statistical significance between moderately cross-linked polyethylene liner and vitamin E diffused highly cross-linked polyethylene liner. This indicates that vitamin E diffused highly cross-linked polyethylene liner is comparable with the conventional moderately cross-linked polyethylene liner. Vitamin E-infused highly cross-linked polyethylene ( VEPE) showed an almost similar stability with regard to the wear rates and the component showed similar stability with that of moderately cross-linked polyethylene liner.

Value of dual energy CT parameters combined with serum procollagen Ⅰ N-terminal propeptide and beta C-terminal cross-linked telopeptide of type Ⅰ collagen in differential diagnosis of spinal bone metastasis from lung cancer and myeloma / 中国医师进修杂志

Objective:To analyze the value of dual energy CT parameters combined with serum procollagen Ⅰ N-terminal propeptide (PⅠNP) and beta C-terminal cross-linked telopeptide of type Ⅰ collagen (β-CTX) in differential diagnosis of spinal bone metastasis from lung cancer and myeloma.Methods:The clinical data of 54 patients with spinal bone metastasis from lung cancer and 50 patients with myeloma in Jincheng People′s Hospital from October 2019 to March 2021 were analyzed retrospectively. All patients were examined by dual energy CT on the day of admission, and the CT values at the energy levels of 40 to 80 keV (energy interval of 10 keV) were recorded. The serum PⅠNP and β-CTX levels were detected by chemiluminescent assay before treatment. The pathological examination results were taken as gold standard, and the CT values at the energy levels of 40 to 80 keV by dual energy CT and serum PⅠNP and β-CTX levels were compared between 2 groups. Receiver operating characteristic (ROC) curve was used to analyze the differential diagnosis value of the CT values at the energy levels of 40 to 80 keV, serum PⅠNP and β-CTX levels alone and combination.Results:The CT values at the energy levels of 40 to 80 keV by dual energy CT and serum PⅠNP and β-CTX levels in patients with spinal bone metastasis from lung cancer were significantly higher than those in patients with myeloma: 79.86 (61.20, 116.32) HU vs. 58.29 (46.92, 64.03) HU, 64.48 (50.27, 90.08) HU vs. 45.78 (38.59, 56.75) HU, 57.35 (43.31, 78.04) HU vs. 43.62 (36.91, 54.06) HU, 52.05 (42.98, 75.79) HU vs. 41.26 (32.84, 51.76) HU, 45.52 (38.55, 63.59) HU vs. 36.68 (28.72, 49.83) HU, 66.35 (31.15, 81.97) μg/L vs. 31.38 (27.76, 34.50) μg/L and 0.61 (0.48, 0.67) μg/L vs. 0.49 (0.47, 0.52) μg/L, and there were statistical differences ( P<0.05 or <0.01). ROC curve analysis result showed that the sensitivity of the combination of the CT values at the energy levels of 40 to 80 keV by dual energy CT was higher than those alone (83.33% vs. 59.26%, 61.11%, 62.96%, 64.81% and 66.67), the area under the curve (AUC) was also higher than those alone (0.882 vs. 0.798, 0.811, 0.817, 0.801 and 0.773), and there were statistical differences ( P<0.01 or <0.05); the sensitivity of the combination of serum PⅠNP and β-CTX levels was higher than those alone (81.48% vs. 57.41% and 62.96%), the AUC was higher than those alone (0.829 vs. 0.753 and 0.729), and there were statistical differences ( P<0.01 or <0.05); the sensitivity of all indexes combined in the differential diagnosis of spinal bone metastasis from lung cancer and myeloma was higher than those of the combination of the CT values at the energy levels of 40 to 80 keV by dual energy CT, the combination of serum PⅠNP and β-CTX levels (98.15% vs. 83.33% and 81.48%), the same as AUC (0.976 vs. 0.882 and 0.829), and there were statistical differences ( P<0.01); there were no significant differences in the specificity of each index alone and combination ( P>0.05). Conclusions:Compared with myeloma, the CT values at the energy levels of 40 to 80 keV by dual energy CT, serum PⅠNP and β-CTX levels in patients with spinal bone metastasis from lung cancer are increased, and the combination of the above indexes has ideal value in differential diagnosis of the two diseases.

Analysis on the risk of refracture after osteoporotic vertebral fracture with changes in blood calcium and bone metabolism / 中华内分泌外科杂志

Objective:To study the risk of refracture after osteoporotic vertebral fracture with changes in blood calcium and bone metabolism.Methods:260 patients with osteoporotic vertebral fracture treated in our hospital from Feb. 2018 to Feb. 2020 were selected for study. All patients were treated with kyphoplasty. The clinical curative effect, blood calcium, PINP, and β-CTX level changes were observed, postoperative recurrence was followed up. Clinical data of fracture patients were collected, risk factors of osteoporotic vertebral fractures in patients with postoperative recurrence of fracture were analyzed, receiver-operating characteristic curve was drawn to analyze the predictive value of blood calcium, PINP, andβ-CTX in postoperative recurrence of osteoporotic vertebral fracture.Results:The total clinical response rate was 95.77% (249/260) after treatment. After treatment, serum calcium, PINP, and β-CTX decreased with time, and the difference was significant ( P<0.05) . All patients were followed up for 6 months. There were 81 cases (31.15%) suffering postoperative fracture and 179 cases (68.85%) without fracture. According to univariate analysis, there were no statistically significant differences in age, sex, BMI, history of trauma, underlying disease, site of surgical vertebral body, segment of surgical vertebral body, correction angle of sagittal kyphosis, or amount of bone cement injection between the two groups ( P>0.05) . Long-term history of glucocorticoid use, preoperative fractured vertebra number, surgical vertebra number, blood calcium, PINP, β-CTX, fracture compression rate, vertebra height recovery rate, reinforced vertebra number, and bone cement leakage were correlated with postoperative recurrence of fracture in patients with osteoporotic vertebral fracture ( P<0.05) . Multivariate Logistic analysis showed that long-term history of glucocorticoid use, preoperative number of fractured vertebrae, surgical vertebra number, fracture compression rate, vertebral height recovery rate, enhanced vertebral body number, bone cement leakage, blood calcium, PINP, and β-CTX were all independent risk factors for postoperative recurrence of osteoporotic vertebral fracture ( P<0.05) . ROC curve results showed that AUC, 95%CI and truncation value were 0.820, 0.770-0.871 and 2.12mmol/L vs 0.915, 0.873-0.957 and 45.51 ng/mL vs 0.973, 0.957-0.988, and 463.29 for serum calcium, PINP, and β-CTX respectively in predicting the recurrence of osteoporotic vertebral fracture. Conclusion:Kyphoplasty has a significant effect on osteoporotic vertebral fracture, and it can effectively improve the serum calcium, PINP, and β-CTX, which have a certain monitoring value for postoperative recurrence of fracture.

Changes of fibrinogen and collagen metabolism after cardiac surgery and their relationship with postoperative atrial fibrillation: A prospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. Methods    Patients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). Results    A total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 h and 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. Conclusion    This study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.

Evaluación costo-efectividad de las prótesis con superficie cerámica-polietileno vs. metal-polietileno para reemplazo articular primario de cadera en Colombia / Cost-Effectiveness of Ceramic-Polyethylene Vs Metal-Polyethylene Bearing for Primary Total Hip Replacement in Colombia

Introducción Existe una diferencia estadísticamente significativa del 1.2% en la tasa de revisión a 15 años a favor de cerámica- polietileno altamente entrecruzado (CP), demostrada en el registro nacional de artroplastia australiano. Nuestro objetivo es evaluar la costo-efectividad entre los pares: cerámica-polietileno altamente entrecruzado (CP) y metal- polietileno altamente entrecruzado (MP) para el pagador en Colombia. Materiales y métodos Se construyó un árbol de decisiones TreeAge Pro® comparando CP vs MP desde la perspectiva del Sistema de Salud Colombiano (SSC). Los parámetros se tomaron de la mejor evidencia disponible, para la efectividad se realizó una revisión sistemática de la literatura y para los costos se usaron tarifas del mercado local. Se determinó la relación de costo-efectividad incremental, asumiendo un horizonte temporal de 15 años y aplicando una tasa de descuento del 5% para costos y efectividad. La incertidumbre fue controlada por un análisis de sensibilidad determinístico y probabilístico. Resultados Para el SSC, con un umbral de 1 PIB per cápita por año de vida ganado ajustado por calidad (AVAC), en adultos llevados a RTC el uso de CP no es costo-efectiva, dado que la efectividad es similar (MP:11,32 AVAC vs CP: 11,36 AVAC) y el costo es tres veces mayor (MP $ 861.826 COP vs CP $ 2.298.090 COP). El análisis de sensibilidad determinístico demuestra que la variable más importante en el resultado es el costo de la cerámica. Discusión Para el SSC el uso rutinario de cabezas de cerámica en RTC no es una estrategia costo-efectiva.

Background There is a statistically significant difference of 1.2% in the revision rate in a 15 year follow in favour of the use of ceramic on highly cross-linked polyethylene (CP) recently described in the Australian National Joint Registry. The purpose of this study is to compare the cost-effectiveness of CP implants and metal-on-highly cross-linked polyethylene (MP) implants in patients undergoing total hip replacement (THR). Materials and methods A TreeAge Pro® decision tree was constructed in order to determine cost-effectiveness between two bearing surfaces: CP or MP from the perspective of the Colombian Health Care System (CHCS). The model parameters where taken from the best available evidence. For the effectiveness, a systematic review of the literature was performed, and costs were taken from local market rates. The incremental cost-effectiveness ratio was determined assuming a time horizon of 15 years, and a discount rate of 5% was used for costs and effectiveness. Cost-effectiveness uncertainty was controlled with deterministic and probabilistic sensitivity analysis. Results For the CHCS, with a 1PIB per capita threshold adjusted per QALY in adults undergoing (THR), the use of a CP implant is not cost-effective, given that the effectiveness is similar (11.32 QALY for MP vs 11.36 QALY for CP), and the cost is three times higher (MP $ 861.826 COP vs CP $ 2.298.090 COP). The deterministic sensitivity analysis showed that the most important variable in the results is the ceramic cost. Discussion for the CHCS the routine use of ceramic-highly cross-linked polyethylene bearing surface in a THR is not a cost-effective strategy.

Does the addition of vitamin E to conventional UHMWPE improve the wear performance of hip acetabular cups? Micro-Raman characterization of differently processed polyethylene acetabular cups worn on a hip joint simulator

In knee replacements, vitamin E-doped ultra-high molecular weight polyethylene (UHMWPE) shows a better wear behavior than standard UHMWPE. Therefore, different sets of polyethylene (PE) acetabular cups, i.e. standard UHMWPE and cross-linked polyethylene irradiated with 50 kGy and 75 kGy, were compared, at a molecular level, with vitamin E-doped UHMWPE to evaluate their wear performance after being tested on a hip joint simulator for five million cycles. Unworn control and worn acetabular cups were analyzed by micro-Raman spectroscopy to gain insight into the effects of wear on the microstructure and phase composition of PE. Macroscopic wear was evaluated through mass loss measurements. The data showed that the samples could be divided into two groups: 1) standard and vitamin E-doped cups (mass loss of about 100 mg) and 2) the cross-linked cups (mass loss of about 30-40 mg). Micro-Raman spectroscopy disclosed different wear mechanisms in the four sets of acetabular cups, which were related to surface topography data. The vitamin E-doped samples did not show a better wear behavior than the cross-linked ones in terms of either mass loss or morphology changes. However, they showed lower variation at the morphological level (lower changes in phase composition) than the UHMWPE cups, thus confirming a certain protecting role of vitamin E against microstructural changes induced by wear testing.

Histocompatibility of poly(L-lactide-co-ε-caprolactone)/cross-linked polyvinylpyrrolidone ureteral stent grafted into the rat bladder / 中国组织工程研究

BACKGROUND: With the development of tissue engineering, materials science, and biomechanics, developing new biodegradable ureteral stent has become an issue of concern. The ureteral stent with poly(L-lactide-co-ε-caprolactone)/crosslinked polypyrrolidone was prepared. OBJECTIVE: To explore the histocompatibility of the ureteral stent grafted into the bladder of Sprague-Dawley rats. METHODS: Sixty male Sprague-Dawley rats (provided by Laboratory Animal Center of Sichuan Academy of Traditional Chinese Medicine) were randomly divided into four groups, each group containing 15 rats. The sham operation group was directly sutured after opening a small incision on the outside of the bladder, and no material was implanted. The other three groups were implanted with polyurethane ureteral stent (control group), poly(L-lactide-co-ε-caprolactone)/8% cross-linked polyvinylpyrrolidone ureter stent (experiment group 1), poly(L-lactide ε- caprolactone)/5% cross-linked polyvinylpyrrolidone ureteral stent (experiment group 2) after opening a small incision on the outer side of the bladder, followed by suturing the incision. At 4, 8, and 16 weeks after operation, the local anatomy of the bladder was observed. The histocompatibility of the materials in each group was observed by hematoxylin-eosin staining. The study was approved by the Ethical Committee of Laboratory Animal Analysis and Testing Center of West China School of Public Health, Sichuan University. RESULTS AND CONCLUSION: (1) Gross observation: At 4, 8 and 16 weeks postoperatively, different degrees of chronic inflammation reaction occurred in the control group and experimental group 1. In the experiment group 2, chronic inflammatory reaction appeared at 4 weeks postoperatively. The stone formation rate in the control group and experimental group 1 was significantly higher than that in the sham operation group (P 0. 05). The calculus formation rate in the experimental group 2 was significantly higher than that in the sham operation group only at 4 weeks postoperatively, and had no significant difference at other time points (P > 0. 05). (2) Pathological observation: Different degrees of foreign body in the outer membrane, inflammatory reaction and diffuse hyperplasia of the mucosa were found in the control group, experimental groups 1 and 2 at different time points postoperatively. There was no significant difference in the rate of diffuse hyperplasia of the mucosa at different time points postoperatively among groups (P > 0. 05), but higher than that in the sham operation group (P < 0. 05). (3) These results indicate that the calculus formation rate and bladder histological reaction of poly(L-lactide-co-ε-caprolactone)/cross-linked polyvinylpyrrolidone ureter stent are comparable with those of commercial ureteral stents, especially the addition of 5% cross-linked polyvinylpyrrolidone has better histocompatibility.

Host response in vivo and the expression of IL-4 in different cross-linked hyaluronic acid composite gels / 国际生物医学工程杂志

Objective To observe the host response and the expression of interleukin-4 (IL-4) in different cross-linked hyaluronic acid composite gels at different time points after the implantation in vivo, and to explore the significance of biocompatibility and macrophage polarization in post-implantation inflammatory response and tissue remodeling. Methods New Zealand white rabbits were respectively injected with crosslinked hyaluronic acid-crosslinked hydroxypropyl methylcellulose gel (sample 1), crosslinked hyaluronic acid-hydroxypropyl methylcellulose gel (sample 2) and commercially available modified sodium hyaluronate gel (control) in subcutaneous tissue at both sides of the spine. Then the rabbits were dissected at 1, 4 and 12 weeks after the implantation. The tissues were fixed with 10％formaldehyde solution, embedded in paraffin and sliced. Hematoxylin-eosin (HE) staining was performed to observe the degree of inflammation and fibrosis. Masson staining was performed to observe the formation of collagen fibers. Immunohistochemical staining was performed to observe the expression of IL-4. Results The results of HE staining showed that the inflammatory reaction in the sample 1 and sample 2 groups was significantly higher than that in the control group 1 and 4 weeks after the implantation. The inflammatory cells aggregated, and the wall of capsule and microcapsule was thick. The sample 1 group was more obvious, and the result was mild stimulation. For all the groups, the results were all non-irritating at 12 weeks after the implantation. The results of Masson staining showed that the collagen fibers in the sample 1 and sample 2 groups were increased compared with the control group, mainly distributed around the implantation site, and a small amount among the gels after 1 and 4 weeks. After 12 weeks, the collagen fibers were further increased, especially among the gels, which were consistent with the control group. The results of immunohistochemical staining showed that, at the same time point, the expression of IL-4 in sample 1 and sample 2 groups was higher than that in the control group, and the expression of IL-4 increased gradually with time. The expression of IL-4 in the control and sample 1 group at 12 weeks after the implantation was higher than that at 1 and 4 weeks respectively, and the differences were statistically significant (all P<0.05). In the sample 1 group, the expression of IL-4 at 12 weeks after the implantation was higher than that at 1 week, and the difference was statistically significant (P<0.05). The expression of IL-4 in the sample 1 group was significantly higher than that in the control group at 4 weeks after the implantation, and the difference was statistically significant (P<0.05). Conclusions The two different cross-linked sodium hyaluronate composite gels have good biocompatibility. The formation of collagen fiber and the expression of IL-4 can gradually increased within 12 weeks after the subcutaneous implantation, which is beneficial to the tissue remodeling.

Study on preparation, characterization, and transformation of icariin of immobilized snailase on nano-SiO2 / 中草药

Objective: To prepare the immobilized snailase on cross-linked nano-SiO2, characterize its physicochemical properties, and investigate the optimal conditions of hydrolyzing icariin to baohuoside Ⅰ and enzymatic properties. Methods: The snailase was immobilized on the glutaraldehyde cross-linked nano-SiO2 by covalent coupling method. The immobilization conditions were optimized using the relative enzyme activity as the test index. Transmission electron microscopy (TEM), fourier transform infrared spectroscopy (FTIR), and elemental analysis methods were used to characterize the physicochemical properties of immobilized snailase. Using icariin as the substrate and free enzyme as the control, the optimal enzyme conditions, enzymatic kinetic parameters, recyclability, and thermal stability of the immobilized snailase were also investigated. Results: The optimal mass ratio of enzyme to carrier was 1:3 and the optimal immobilization time was 6 h for the preparation of the immobilized snailase. The optimum hydrolysis conditions of the immobilized snailase were as follows: pH 5.0, conversion temperature 60 ℃, mass ratio of enzyme to substrate 1:2, and transformation time 12 h. The Vmax and Km of the immobilized snailase was 0.43 μg/min and 0.78 mmol/L, respectively. After repeated use for 5 times, the residual relative enzyme activity of the immobilized snailase maintained above 70%. Conclusion: The immobilized snailase on cross-linked nano-SiO2 has high mechanical strength, strong stability, and good reusability. It can hydrolyze the icariin to the baohuoside Ⅰ with a better activity. The hydrolysis process was simple, easy, and suitable for industrial production.

Genipin cross-linked decellularized scaffold for allogenic transplantation in situ / 国际生物医学工程杂志

Objective@#To explored the bio-compatibility and cartilage regeneration of the rabbits genipin cross-linked decellularized scaffold, to provide experimental and theoretical support for the clinical application of genipin cross-linked decellularized scaffold.@*Methods@#Detergent-enzyme method was used to prepare decellularized tracheal scaffolds. Cellular content of native trachea and decellularized trachea were compared by 4′, 6-diamidino-2-phenylindole(DAPI) staining. Masson trichrome staining was used to compare the histological structure of the progenitor tube, decellularized trachea, and genipin cross-linked decellularized trachea. Nine adult New Zealand white rabbits were randomly divided into autologous tracheal transplantation group (negative control group), allogeneic tracheal transplantation group (positive control group), and genipin cross-linked decellularized tracheal transplantation group (experimental group). Autologous bone marrow mesenchymal stem cells were implanted on the surface of trachea in each group. The blood cells and type II collagen were detected to compare the inflammatory response and chondrocyte regeneration after tracheal orthotopic transplantation in the three groups.@*Results@#After DAPI staining and light microscope observation (×200), the cell content of the acellular 7-cycle trachea [(143.0 ± 71.1) cells/field] was significantly lower than that of the native trachea [(853.5 ± 149.6) cells/field], and the difference was statistically significant (P<0.001). Masson′s trichrome staining showed that the tissue structure of genipin cross-linked decellularized trachea was more complete. Blood cell analysis and type II collagen test results showed that genipin cross-linked decellularized trachea transplanted with bone marrow mesenchymal stem cells after transplantation in situ has little rejection and can be converted into chondrocytes by the action of related growth factors in vivo.@*Conclusions@#Genipin cross-linked decellularized tracheal scaffold combined with stem cell transplantation can successfully construct a tracheal in situ replacement model. This study provides a strong support for the research of tissue engineering trachea.

The preparation and study on drug release of a triply-responsive (redox/thermo/pH) cross-linked polymeric micelle as anti-cancer drug carrier / 生物医学工程学杂志

A multiple-stimuli-responsive drug-conjugated cross-linked micelles was prepared by radical copolymerization. The chemical structure, morphology, and size of the cross-linked micelles were characterized, and the drug loading of the micelle was calculated. The experimental results indicated that the hydrodynamic size of the drug-loaded micelles were about 100 nm, and the as prepared micelles could be degraded and swelled in presence of reducing glutathione (GSH). The low critical solution temperature (LCST) of the micelle was around 39.4℃. According to the experimental results, the micelles will shrink at temperature above the LCST. Subsequently, the accumulative drug release rate was up to 91.78% under acidic (pH 5.0), reductive (GSH 10 mmol/L) and high temperature (42.0℃) conditions mimicking the tumor microenvironment, while a relatively low release rate of 1.12% was observed without stimulation. The drug-conjugated cross-linked micelles showed a strong cell uptake behavior. In the cytotoxicity assay, the micelles exhibited effective anti-cancer activity and excellent biocompatibility. In brief, the experimental results show that the as-prepared drug-conjugated cross-linked micelle exhibits multiple stimuli-responsiveness, which holds great promise for anti-cancer drug delivery.

Cementless Total Hip Arthroplasty Using Ceramic Femoral Head on Cross-Linked Ultra-High-Molecular Weight Polyethylene Liner in Patients Older than 65 Years: Minimum Five-Year Follow-Up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the utility of ceramic-on-polyethylene articular bearing surface when cementless total hip arthroplasty is performed in patients older than 65 years through an analysis of the minimum five-year follow-up results using the ceramic femoral head and cross-linked polyethylene liner. MATERIALS AND METHODS: From March 2010 to September 2012, 51 patients (56 hips) who were older than 65 years were enrolled in this retrospective study. The mean age at surgery was 70.9±5.1 years old. A clinical assessment was analyzed using the Harris hip score. For the radiographic assessment, the cup inclination and anteversion, stem alignment, and wear amount were measured. The postoperative complications were also determined. RESULTS: The mean Harris hip score was improved from preoperative 48 points to postoperative 87 points (p < 0.05). The mean cup inclination was 40.9°±6.4° and the mean cup anteversion was 20.3°±8.1°. The mean cup anteversion of the elevated liner-used group (16 cases) was 14.3°±7.9° and the mean cup anteversion of the neutral liner used group (40 cases) was 22.4°±9.1° (p < 0.05). The mean stem alignment angle was 0° (range, varus 4°–valgus 4°). The mean linear wear amount was 0.458±0.041 mm and the average annual linear wear rate was 0.079±0.032 mm/yr. Six cases (10.7%) of intraoperative periprosthetic femoral fractures were encountered. CONCLUSION: Based on these results, the use of a ceramic-on-polyethylene articular bearing surface in elderly patients with cementless total hip arthroplasty is beneficial. On the other hand, careful effort is needed to prevent intraoperative periprosthetic femoral fractures.

Five Years' Outcomes of Trabeculectomy with Cross-linked Sodium Hyaluronate Gel Implantation for Chinese Glaucoma Patients / 中华医学杂志(英文版)

<p><b>Background</b>Trabeculectomy is the most efficient surgical treatment. Prevention failure of bleb cicatrix would lead to unsatisfactory postoperative intraocular pressure (IOP) controlling and unsatisfactory success rate. The aim of this study was to evaluate the 5-year outcomes of trabeculectomy with a cross-linked sodium hyaluronate gel implantation for Chinese glaucoma patients.</p><p><b>Methods</b>This is a prospective, case-controlled study. Patients who were to be applied first-time trabeculectomy in the Department of Ophthalmology of Peking University Third Hospital between 2010 and 2012 were included in the study. Totally, 60 eyes were randomly assigned to the trabeculectomy group (TA group) or the trabeculectomy with cross-linked sodium hyaluronate gel implantation group (TH group). Follow-up was finished at 1 week, 1 month, 3 months, 1 year, 3 years, and 5 years after the operation. The statistical index of demographic data, IOP, bleb shape, and any complications or medications or surgical procedures were recorded and assessed by SPSS 19.0 software through independent t-test, one-way analysis of variance (ANOVA) and Pearson's Chi-square test, respectively.</p><p><b>Results</b>The baseline IOP was comparable between the two groups (t= -1.00, P= 0.32) while the postoperative IOP was significantly lower in the TH group at 1, 3 and 5 years' time points (P = 0.00, P= 0.01 and P = 0.01, respectively). According to the Indiana Bleb Appearance Grading Scale, the height and extent of bleb were better in the TH group at all follow-up time points (P < 0.05), however, the comparison of bleb vascularity showed no statistical difference (P > 0.05). TA group had a higher percentage of complications (13% vs. 3%) compared to TH group; however, there was no statistical difference in the comparison of each statistical item (P > 0.05, respectively). The complete success at 5 years was higher in the TH group than that in the TA group (78% vs. 54%, P = 0.03).</p><p><b>Conclusion</b>Our results suggested that implantation of cross-linked sodium hyaluronate gel with trabeculectomy was more efficient and would improve the prognosis of glaucoma patients.</p>

Preparation and Rheological Property of Cross-Linked Sodium Hyaluronate Gel / 中国药学杂志

OBJECTIVE: To prepare crossed-linked sodium hyaluronate (CHA) gel and study its rheological property. METHODS: CHA was prepared using 1, 4-butanediol diglycidyl ether (BDDE). The linear viscoelastic properties and creep recovery of hyalouronan(HA) and CHA were measured with a rheometer. The influencing factors of rheological properties were analyzed, such as concentration, proportion of cross-linker and temperature. RESULTS: Cross-linked sodium hyaluronate gel was prepared. The viscoelasticity was measured with a pair of 20 mm stainless steel plates at the frequency of 1 Hz and shear-strain of 1 Pa at (25±0.1)℃. As shown by the creep recovery test, CHA had a smaller strain and shorter time to recover to the minimum strain than HA, which showed typical linear viscoelastic and creep recovery properties. CONCLUSION: CHA is a non-Newtonian fluid, which is easy to administer and conforms completely to the requirements for viscoelastic supplementation materials for intra-articular injection. Compared with HA, CHA has more advantageous viscoelastic property and stability.

Elimination of unplanned treatment breaks and dose reductions caused by mucositis: Positive implications for survival outcomes and cost reductions using high potency polymerized cross-linked sucralfate in 55 patients undergoing radiation for head and neck cancer with and without chemotherapy

PURPOSE: Annually 27,855 patients in Korea develop treatment-induced mucositis nearly doubling the cost of cancer care. It is an emergency medical condition causing unplanned treatment breaks in 4,998 patients. The subsequent reduction in optimal dose-intensity causes premature deaths due to lower 5-year survival. An additional 216 patients die from mucositis-mediated sepsis and infection. Thus complete elimination of mucositis will immediately reduce the cost of care while simultaneously eliminating 5,214 mucositis-associated deaths. High potency polymerized cross-linked sucralfate (HPPCLS) cleared by the US Food and Drug Administration has been associated with the elimination of mucositis.METHODS: Observational, self-reporting, practice-based mucositis registry. Inclusion criteria: any patient with chemoradiation-induced mucositis. Exclusion criteria: previous adverse reaction to sucralfate products. Primary outcome: rapid reversal or complete prevention. Conduct of study: 28 radiation oncologists from 21 different institutions prescribed HPPCLS to 55 patients undergoing chemoradiation for squamous cell carcinoma of head and neck and esophagus to eliminate mucositis-associated treatment breaks.RESULTS: All patients with World Health Organization grade 1 (n=6), grade 2 (n=23), grade 3 (n=16) oral mucositis, and grade 2 esophageal mucositis (n=2) experienced complete reversal of mucositis. Within 2–3 days both mucosa and swallowing normalized. Anticipated grade 3/4 mucositis was prevented in 8 out of 8 elderly patients aged 78–93 avoiding gastrostomy tube placement. Statistical analysis of outcomes: Outcomes qualified as a positive Glasziou treatment effect that was statistically significant (P<0.05).CONCLUSION: HPPCLS eliminated mucositis by rapid reversal or complete prevention, thereby eliminating unplanned treatment breaks. It may likely reduce mucositis-associated increased cost of care and premature deaths.

Results of Total Hip Arthroplasty with 36-mm Metallic Femoral Heads on 1st Generation Highly Cross Linked Polyethylene as a Bearing Surface in Less than Forty Year-old Patients: Minimum Ten-year Results / 대한고관절학회지

PURPOSE: We evaluated long-term clinical and radiographic results in patients underwent primary total hip arthroplasty (THA) using 36-mm metallic femoral head and 1st generation highly cross-linked polyethylene among patients aged 40 years and less, with minimum 10 years follow-up. MATERIALS AND METHODS: We retrospectively reviewed 20 hips underwent primary THA by one hip surgeon using 36-mm femoral head and 1st generation highly cross-linked polyethylene from 2004 to 2006. Mean follow up was 131.55 months. Clinical follow-ups included functional measurements. And we evaluated post operative complications, prosthesis loosening, failure, and osteolysis. For radiologic evaluations, together with position of acetabular cup at 6 weeks later of postoperation, we separately calculated the penentrations of femoral heads into polyethylene liners during postoperation and one year later check-ups, and during one year later check-ups and final check-ups. Polywear pro3D 5.10 software was used to measure penetrations of femoral head. RESULTS: Mean acetabular cup inclination and anteversion were 49.02° and 10.19°, respectively. Mean thickness of the polyethylene liner at 45° was 6.44 mm. There were no major complications such as implant loosening or osteolysis, and one case of dislocation occurred. Average modified Harris hip score at final follow-up was 91, and Merle d'Aubigne and Postel scores 15 were or over. Average femoral head penetration of bedding wear was 0.170±0.039 mm/year. Steady-state wear rates was 0.059±0.006 mm/year. CONCLUSION: Results of THA with 36-mm metallic femoral heads on 1st generation highly cross linked as a bearing surface in less than 40 year-old patients were satisfactory.

Clinical value of serum N-MID,total TP1NP,β-CTx detection combination with whole-body bone scintigraphy in early diagnosis of bone metastasis in patients with malignant tumor / 国际检验医学杂志

Objective To investigate the clinical value of bone metabolism biochemical marker N-MID,TP1NP and beta-CTx combined with whole body bone scintigraphy in early diagnosis of bone metastasis of tumor.Methods The concentration of the 3 markers were measured by the electrochemical luminescence analysis method in 30 cases of healthy control group and 210 cases of patients with malignant tumor,which were divided into non bone metastasis group(45 cases) and bone metastasis group(165 cases).The bone metastasis group were divided into 4 grades(0-grade Ⅲ) by Soloway classification according to whole body bone imaging.Results The levels of serum N-MID,TP1NP and beta-CTx in 165 malignant tumor patients with bone metastasis were significantly higher than in 45 malignant tumor patients with bone metastasis and in 30 healthy control group,the difference was statistically significant(P<0.05).With the increase of the number of metastatic lesions in the bone metastasis group,the serum levels of N-MID,TP1NP,and beta-CTx were increased gradually,and they were positively correlated with the progression of the disease.According to the analysis of ROC curve,the cut-off value,sensitivity and specificity in the diagnosis of tumor bone metastasis were 17.59 ng/mL,70.3％,88.9％ for serum N-MID,43.04 ng/mL,78.2％,95.6％ for TP1NP,and 0.48 ng/mL,73.9％,93.3％ for beta-CTx.Under the ROC curve(AUC) was 0.831 for serum N-MID,0.890 for TP1NP,and 0.869 for beta-CTx.The sensitivity and specificity of three bone metabolic markers in the diagnosis of bone metastasis of malignant tumor were significantly higher.Conclusion Bone metabolism biochemical markers:Serum N-MID,TP1NP and beta-CTx for diagnosis of bone metastasis of malignant tumor are sensitive,accurate and simple,which can significantly improve the efficiency of diagnosis of bone metastasis,and can be combined with whole-body bone scintigraphy in early diagnosis of bone metastasis with malignant tumor.

Preparation Technology Screening of Activated Carbon N-acetylcysteine Microcapsule / 中国药房

OBJECTIVE:To prepare Activated carbon N-acetylcysteine microcapsule (ACNAC),and to optimize preparation technology. METHODS:ACNAC was prepared by emulsion cross-linked method using biodegradable material gelatin as capsule wall material. Using comprehensive evaluation index of drug-loading amount,entrapment rate and particle size distribution percent-age(the percentage of 80-140 μm particle)as index,drug-loading ratio,amount of gelatin,mixing speed and the amount of emul-sifier as factors,single factor test and orthogonal test were used to optimize formulation technology. The technology was validated and distribution of particle size of ACNAC was determined. RESULTS:The optimal formulation technology was as follows as drug-loading ratio 1∶1,gelatin 15%,emulsifier 2.0%,mixing speed 1 000 r/min. Average drug-loading amount of 6 batches of ACNAC was 15.9%(RSD=1.21%),average encapsulation efficiency was 78.1%(RSD=1.11%)and average particle size distri-bution percentage was 81.9%. CONCLUSIONS:ACNAC is prepared successfully,and formulation technology is reasonable and feasible.

Structural regulation by calcium ion in preparing cross-linked enzyme aggregates / 生物工程学报

We studied the effect of calcium ion on particle size and pore structure of cross-linked enzyme aggregates (CLEAs) of glucose oxidase, with activity and stability of the enzyme as evaluation criteria. With calcium ion to prepare CLEA significantly decreased particle sizes of CLEAs whilst the pore structures of CLEAs gradually disappeared with the increase of calcium concentration. When glucose oxidase was precipitated at 0.1 mmol/L Ca²⁺, glucose oxidase in CLEA showed the definitive pore structure. Moreover, glucose oxidase activity in CLEA with Ca²⁺ was 1.69 times higher than that without Ca²⁺. Even at Ca²⁺ as high as 1.0 mmol/L, glucose oxidase activity in CLEA was 42% higher than that of CLEA without Ca²⁺. Furthermore, CLEA prepared with 0.1 mmol/L Ca²⁺ not only exhibited higher substrate conversion and operational stability, but also increased the maximum reaction speed. Therefore, calcium ion improved the performance of glucose oxidase in CLEAs.

Results of Primary Total Hip Arthroplasty Using 36 mm Femoral Heads on 1st Generation Highly Cross Linked Polyethylene in Patients 50 Years and Less with Minimum Five Year Follow-up / 대한고관절학회지

PURPOSE: We evaluated the clinical and radiographic midterm results of primary total hip arthroplasty (THA) using a 36 mm diameter femoral head on 1st generation highly cross-linked polyethylene (HXLPE) in patients 50 years and less with minimum five year follow-up. MATERIALS AND METHODS: We retrospectively reviewed 31 patients (41 hips) aged 50 years and less underwent primary THA with a 36 mm diameter femoral head on HXLPE between 2004 and 2010. Clinical follow-ups included specific measurements like modified Harris hip scores (HHS) and Merle d'Aubigne and Postel score. For radiologic evaluations, together with position of acetabular cup at six weeks later of postoperation, we separately calculated the penentrations of femoral head into polyethylene liners during postoperation and one year later check-ups, and during one year later check-ups and final check-ups. RESULTS: There were no major complications except for one case of dislocation. Average modified HHS at final follow-up was 88 (81-98), and Merle d'Aubigne and Postel scores were more than 15. Mean acetabular cup inclination and anteversion were 45.81°(36.33°-54.91°) and 13.26°(6.72°-27.71°), respectively. Average femoral head penetration of steady-state wear rate determined using radiographs taken at one-year postoperatively and at latest follow-up was 0.042±0.001 mm/year. CONCLUSION: Based on minimum 5 years clinical results, we think 36 mm metal head coupling with HXLPE as the good alternate articulation surface when planning THA for patients aged 50 years and less.