Synthesis and Characterization of Renewable Polyester Coil Coatings from Biomass-Derived Isosorbide, FDCA, 1,5-Pentanediol, Succinic Acid, and 1,3-Propanediol.

Biomass-derived polyester coatings for coil applications have been successfully developed and characterized. The coatings were constituted by carbohydrate-derived monomers, namely 2,5-furan dicarboxylic acid, isosorbide, succinic acid, 1,3-propanediol, and 1,5-pentanediol, the latter having previously been used as a plasticizer rather than a structural building unit. The effect of isosorbide on the coatings is widely studied. The inclusion of these monomers diversified the mechanical properties of the coatings, and showed an improved performance against common petrochemical derived coatings. This research study provides a range of fully bio-derived polyester coil coatings with tunable properties of industrial interest, highlighting the importance of renewable polymers towards a successful bioeconomy.

Compositional tuning of epoxide-polyetheramine "click" reaction toward cytocompatible, cationic hydrogel particles with antimicrobial and DNA binding activities.

UNLABELLED: The "click" characteristics of nucleophilic opening of epoxide have recently been exploited for the development of a functional hydrogel particle system based on commercially available bisepoxide and triamine polyetheramine monomers. Key features of these particles include high cationic charges and responsiveness to temperature, pH, and oxidation. Despite these advantages, the cytocompatibility of these particles must be considered prior to use in biomedical applications. Here we demonstrate that, by introducing a diamine polyetheramine as a comonomer in the "click" reaction, and tuning its molar ratio with the triamine monomer, cationic nanoparticles with improved cytocompatibility can be prepared. The reduced cytotoxicity is primarily due to the hydrophilic backbone of the diamine comonomer, which has polyethylene glycol as a primary component. The resulting nanoparticles formed from the diamine comonomer exhibited a lower surface charge, while maintaining a comparable size. In addition, the responsiveness of the nanoparticles to temperature, pH, and oxidation was conserved, while achieving greater colloidal stability at basic pH. Results from this study further demonstrated that the nanoparticles were able to encapsulate Nile red, a model for hydrophobic drug molecules, were effective against the bacteria Staphylococcus aureus, and were capable of binding DNA through ionic complexation. Based on the results from this work, the use of diamine comonomers significantly reduces the cytotoxicity of similarly developed hydrogel nanoparticles, allowing for numerous biomedical applications, including nanocarriers for therapeutic agents with poor water solubility, treatment of bacterial infection, and non-viral vectors for gene therapy. STATEMENT OF SIGNIFICANCE: In recent years significant attention has been placed on the development of nanocarriers for numerous biomedical applications. Of particular interest are cationic polymers, which contain high positive surface charges that allow binding of numerous therapeutic agents. Unfortunately, the advantages of cationic polymers for binding, are often negated by the tendency of these polymers to be cytotoxic. Previous studies have developed highly responsive cationic hydrogel nanoparticles, which meet several of the criteria for biomedical applications, but were acutely cytotoxic. In this work, cationic hydrogel nanoparticles, with significantly improved cytocompatibility, were synthesized using simple, green epoxy chemistry. In addition, the ability of these nanoparticles to maintain a small size (<500nm), bind DNA, encapsulate hydrophobic drugs, and kill bacteria was maintained.

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical research" articles in the European Spine Journal 2014.

This is a review of some 50 papers published in the European Spine Journal in the year 2014. They are selected on the basis that the author felt they were significant contributions to the spinal literature in that year. A brief precis is provided of each paper, and each is accompanied by a short discussion explaining its importance and relevance.

A new approach for adipose tissue treatment and body contouring using radiofrequency-assisted liposuction.

A new liposuction technology for adipocyte lipolysis and uniform three-dimensional tissue heating and contraction is presented. The technology is based on bipolar radiofrequency energy applied to the subcutaneous adipose tissue and subdermal skin surface. Preliminary clinical results, thermal monitoring, and histologic biopsies of the treated tissue demonstrate rapid preaspiration liquefaction of adipose tissue, coagulation of subcutaneous blood vessels, and uniform sustained heating of tissue.

A survey of the "surgical and research" articles in the European Spine Journal, 2007.

Over the last couple of years the European Spine Journal has become truly international with papers from all over the world, and at the same time it has increased its size. Professor Mulholland has selected and reviewed some 40 papers from over 200 published in 2007 and that he felt were of particular interest to practicing surgeons and would influence their management of patients, or papers that challenged established beliefs. Papers dealing with back pain, spondylolysis, tumors, spinal stenosis, spinal infection, clinical examination, lumbar disc herniation, spinal fractures, etc. are reviewed and their significance assessed. The aim of the review is to encourage readers to read the papers themselves, hopefully stimulated by the trenchant comments of the reviewer, both critical and laudatory.

The value of nerve root infiltration for leg pain when used with a nerve stimulator.

Randomized comparative study of the efficacy of nerve root infiltration (NRI) guided by neurostimulator to find the value of nerve stimulators in nerve root infiltration was undertaken. The response to nerve root infiltration using local anaesthetics and steroid is unpredictable, partly because the exact nerve root giving rise to pain may not be truly infiltrated. The nerve stimulator is advocated to identify the nerve root of concern prior to infiltration. The current study assessed the results of NRI with and without the nerve stimulator. Ninety-six patients with leg pain awaiting selective nerve root infiltration using long acting local aesthetic, were prospectively randomized into two groups, in the first one, the nerve root block was carried out without nerve stimulator (n = 39) and in the second group the block was carried out with the guidance of a nerve root stimulator (n = 57). Seventy-seven of the patients who had lateral canal stenosis (a total 81) responded to NRI; within this group nerve stimulator was used for 50 patients. Nerve root infiltration was used to relieve post-discetomy leg pain (ten), post-disc prolapse (four) and in one patient post-nucleotomy leg pain. Overall 89% of the patients were responders of NRI. Responders of around 65% had the NRI performed with the aid of stimulator. The response rate to pain was 96% when NRI was guided by a neurostimulator and 79% when no neurostimulator was used. When responded there was no significant statistical difference using the Oswestry disability score between both groups. After excluding disc bulge in patients who respond partially to NRI, it is worthwhile repeating the injection. There was a significant difference in response rate when NRI was done under guidance of a nerve stimulator, the stimulator is safe to use and increases the specificity of the block.

A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results.

The literature reports on the safety and efficacy of titanium cages (TCs) with additional posterior fixation for anterior lumbar interbody fusion. However, these papers are limited to prospective cohort studies. The introduction of TCs for spinal fusion has resulted in increased costs, without evidence of superiority over the established practice. There are currently no prospective controlled trials comparing TCs to femoral ring allografts (FRAs) for circumferential fusion in the literature. In this prospective, randomised controlled trial, our objective was to compare the clinical outcome following the use of FRA (current practice) to the use of TC in circumferential lumbar spinal fusion. Full ethical committee approval and institutional research and development departmental approval were obtained. Power calculations estimated a total of 80 patients (40 in each arm) would be required to detect clinically relevant differences in functional outcome. Eighty-three patients were recruited for the study fulfilling strict entry requirements (>6 months chronic discogenic low back pain, failure of conservative treatment, one- or two-level discographically proven discogenic low back pain). The patients completed the Oswestry Disability Index (ODI), Visual Analogue Score (VAS) for back and leg pain and the Short-Form 36 (SF-36) preoperatively and also postoperatively at 6, 12 and 24 months, respectively. The results were available for all the 83 patients with a mean follow-up of 28 months (range 24-75 months). Five patients were excluded on the basis of technical infringements (unable to insert TC in four patients and FRA in one patient due to the narrowing of the disc space). From the remaining 78 patients randomised, 37 received the FRA and 41 received the TC. Posterior stabilisation was achieved with translaminar or pedicle screws. Baseline demographic data (age, sex, smoking history, number of operated levels and preoperative outcome measures) showed no statistical difference between groups (p<0.05) other than for the vitality domain of the SF-36. For patients who received the FRA, mean VAS (back pain) improved by 2.0 points (p<0.01), mean ODI improved by 15 points (p=<0.01) and mean SF-36 scores improved by >11 points in all domains (p<0.03) except that of general health and emotional role. For patients who received the TC, mean VAS improved by 1.1 points (p=0.004), mean ODI improved by 6 points (p=0.01) and SF-36 improved significantly in only two of the eight domains (bodily pain and physical function). Revision procedures and complications were similar in both groups. In conclusion, this prospective, randomised controlled clinical trial shows the use of FRA in circumferential lumbar fusion to be associated with superior clinical outcomes when compared to those observed following the use of TCs. The use of TCs for circumferential lumbar spinal fusion is not justified on the basis of inferior clinical outcome and the tenfold increase in cost.

Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain.

STUDY DESIGN: An experimental study on cadaver spine and spine model for biomechanical evaluation of a novel dynamic stabilization device. OBJECTIVES: First, to test the hypothesis that in dynamic stabilization of a lumbar spine using pedicle screws and ligament, addition of a fulcrum in front of the ligament can unload the disc. Second, to determine the relationship between the length and stiffness of the fulcrum and the ligament on disc unloading, lordosis and motion preservation. SUMMARY OF BACKGROUND DATA: Activity related low back pain may be attributable to abnormal disc loading or abnormal movement. Spinal fusion addresses both the mechanisms, but it has limitations. Soft stabilization with Graf ligament restricts abnormal movement but increases the disc pressure. The Dynesys system uses a plastic cylinder around the ligament to prevent overloading the disc, but it restricts extension and loses lordosis. METHODS: A novel dynamic stabilization system (fulcrum assisted soft stabilization or FASS) was developed in which a flexible fulcrum was placed in front of a ligament between the pedicle screws. It was hypothesized that the fulcrum should transform the compressive force of a ligament behind into a distraction force in front and unload the disc. Three spine models were developed using wooden blocks for vertebral bodies and neoprene rubber of different hardness for disc. Their load-deformation character was tested and compared with that of the cadaver spine in a spine tester. The spine model with the closest load-deformation property to cadaver spine was then tested for the effect of a FASS system, consisting of high density polythene rod as fulcrums and rubber "O" rings as ligaments. The disc pressure in the spine models were recorded with strain gauge in the center. RESULTS: Application of ligaments alone across the pedicle screws increased the disc pressure, produced a lordosis, and reduced the range of motion. Application of fulcrums reduced the disc pressure and maintained the lordosis. Increasing the fulcrum length resulted in progressive unloading of the disc but increased stiffness of the motion segment. As the fulcrum length approximated the height of the motion segment, the lordosis was lost, and the disc was completely unloaded. Decreasing the lateral bending stiffness of the fulcrum had minimal effect on disc unloading and motion-segment stiffness. CONCLUSION: The novel FASS system can unload the disc, control the range of motion, and maintain lordosis. These parameters may be controlled with a suitable combination of ligament and fulcrum system. The study provides an indication toward the desirable biomechanical properties of the fulcrum and ligament for future development of a clinically applicable prototype.