Orbital Reconstruction in Le Fort III Fractures.

BACKGROUND: Few quantitative results are reported about the surgical effect of orbital reconstruction in Le Fort III fractures. The authors' team proposed an ordered surgery method which was effective for Le Fort III fractures. The aim of this study was to evaluate the effectiveness of this method with quantitative outcomes. METHODS: A retrospective study was conducted of all patients who were diagnosed with Le Fort III fractures and underwent orbital and facial fractures repair from January 2015 to June 2019. Surgical reconstruction was performed with an ordered surgery method. Orbital volumes were used to evaluate the effectiveness of orbital reconstruction. RESULTS: Fifteen patients (21 eyes) with Le Fort III fractures were included in this study. Preoperative and postoperative orbital volume changes were statistically significant ( P <0.01). For unilateral fractures, orbital volumes were different in 2 eyes ( P <0.01). For bilateral fractures, orbital volumes were almost the same in 2 eyes ( P =0.34). For the affected eye in unilateral fractures group and eyes in bilateral fractures group, after surgery, orbital volume were almost the same ( P =0.35). CONCLUSIONS: This study showed effectiveness and safety of the ordered surgery in the treatment of Le Fort III fractures, which would result in significant decrease in orbital volumes.

Bioresorbable Implants in Reduction of Paediatric Zygomaticomaxillary Complex Fractures Concurrent With Internal Orbital Reconstruction.

PURPOSE: To evaluate the clinical effectiveness and safety of bioresorbable implants for treating paediatric zygomaticomaxillary complex (ZMC) fractures with concomitant orbital floor defects. METHODS: A retrospective review of paediatric patients who underwent ZMC repair with concomitant orbital floor fractures with bioresorbable implants in Shanghai Ninth People's Hospital from July 2015 to June 2019 was performed. The primary outcome measures included ocular motility, diplopia, enophthalmos, facial deformities, and restricted mouth opening, as well as complication rates. Pre- and post-operative computed tomography scans were obtained for clinical diagnosis and surgical effectiveness. RESULTS: Twenty two children were included in this study. Facial deformities were corrected in all 22 cases by surgical reconstruction postoperatively, and the average relative distance of Portals point-Zygomaxillare and Anteriornasalspine-Zygomaxillare were 1.3 ± 0.6mm ( P = 0.22) and 1.2 ± 0.5mm ( P = 0.19). The eye movement restored to normal in 13 patients. The mean amount of relative enophthalmos was 1.0 ± 0.4 mm ( P = 0.12). 12 cases had complete resolution of diplopia postoperatively at the extremes of the gaze, and 1 case presented persistent diplopia on the down gaze as before, but from level III to level I. Facial numbness was resolved completely in 6 cases, and 2 cases presented with persistent numbness but relieved significantly. The average Hounsfield units of RapidSorb plates and OrbFloor PI were 154 ± 5 and 99 ± 4 respectively on computed tomography image obtained 1 week postoperatively, which showed no obvious difference compared with 0.5 year postoperatively ( P > 0.1). Hounsfield units of implants gradually declined around 1 year postoperatively. Hounsfield units of RapidSorb plates (20 ± 1) were consistent with periorbital tissue during postoperative 2-year follow-up, and Hounsfield units of OrbFloor PI (19 ± 1) were consistent with periorbital tissue during postoperative 1.5-year follow-up. No patients had severe sequelae or implant related complications postoperatively. None of bone nonunion, malunion, infection or rejection occurred during the follow-up periods. CONCLUSIONS: Open reduction and internal fixation for the treatment of ZMC fracture have achieved significant improvement in functional and cosmetic outcomes postoperatively. Bioresorbable materials have been proved to be effective and safe in the treatment of children's ZMC and orbital wall fractures.

Repairing a Facial Cleft by Polyether-Ether-Ketone Implant Combined With Titanium Mesh.

The Tessier Number 4 cleft is one of the rarest, most complex craniofacial anomalies that presents difficulties in surgical treatment. In this article, we report a case of simultaneous facial depression, eye displacement, and medial canthus deformity. In this case, the maxillary bony defect was reconstructed using computer-assisted design computer-assisted manufacturing (CAD-CAM) polyether-ether-ketone (PEEK) material, and the orbital floor defect was repaired with AO prefabricated titanium mesh. Additionally, the medial canthus was modified with canthopexy and a single Z-plasty flap. Owing to its relative rarity and varied clinical presentations, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. This study presents the combination of CAD-CAM manufactured PEEK material and titanium mesh as an alternative approach for reconstructing the bony defect of Tessier No. 4 facial clefts.

Repair of orbital bone defects in canines using grafts of enriched autologous bone marrow stromal cells.

BACKGROUND: Bone tissue engineering is a new approach for the repair of orbital defects. The aim of the present study was to explore the feasibility of tissue-engineered bone constructed using bone marrow stromal cells (BMSCs) that were rapidly isolated and concentrated from bone marrow (BM) by the red cell lysis method, then combined with ß-tricalcium phosphate (ß-TCP) to create grafts used to restore orbital bone defects in canines. METHODS: In the experimental group, grafts were constructed using BMSCs obtained by red cell lysis from 20 ml bone marrow, combined with ß-TCP and BM via the custom-made stem cell-scaffold device, then used to repair 10 mm diameter medial orbital wall bony defects in canines. Results were compared with those in groups grafted with BM/ß-TCP or ß-TCP alone, or with defects left untreated as controls. The enrichment of BMSCs and nucleated cells (NCs) in the graft was calculated from the number in untreated bone marrow and in suspensions after red cell lysis. Spiral computed tomography (CT) scans were performed 1, 4, 12 and 24 weeks after implantation in all groups. Gross examination, micro-CT and histological measurements were performed 24 weeks after surgery. The results were analyzed to evaluate the efficacy of bone repair. RESULTS: The number of NCs and of colony-forming units within the scaffolds were increased 54.8 times and 53.4 times, respectively, compared with untreated bone marrow. In the BMSC-BM/ß-TCP group, CT examination revealed that the scaffolds were gradually absorbed and the bony defects were restored. Micro-CT and histological examination confirmed that the implantations led to good repair of the defects, with 6 out 8 orbital defects completely restored in the experimental group, while by contrast, the grafts in the control groups did not fully repair the bony defects, a difference which was statistically significant (p<0.05). CONCLUSIONS: Tissue-engineered bone, constructed using BMSCs isolated by red cell lysis of BM, can restore critical-sized orbital wall defects in canines.

The Uptake and Distribution Evidence of Nano- and Microplastics in vivo after a Single High Dose of Oral Exposure.

Objective: Tissue uptake and distribution of nano-/microplastics was studied at a single high dose by gavage in vivo. Methods: Fluorescent microspheres (100 nm, 3 µm, and 10 µm) were given once at a dose of 200 mg/(kg∙body weight). The fluorescence intensity (FI) in observed organs was measured using the IVIS Spectrum at 0.5, 1, 2, and 4 h after administration. Histopathology was performed to corroborate these findings. Results: In the 100 nm group, the FI of the stomach and small intestine were highest at 0.5 h, and the FI of the large intestine, excrement, lung, kidney, liver, and skeletal muscles were highest at 4 h compared with the control group ( P < 0.05). In the 3 µm group, the FI only increased in the lung at 2 h ( P < 0.05). In the 10 µm group, the FI increased in the large intestine and excrement at 2 h, and in the kidney at 4 h ( P < 0.05). The presence of nano-/microplastics in tissues was further verified by histopathology. The peak time of nanoplastic absorption in blood was confirmed. Conclusion: Nanoplastics translocated rapidly to observed organs/tissues through blood circulation; however, only small amounts of MPs could penetrate the organs.

Alkali-oxygen cooking coupled with ultrasonic etching for directly defibrillation of bagasse parenchyma cells into cellulose nanofibrils.

A scheme combining alkali­oxygen cooking and ultrasonic etching cleaning was developed for the short range preparation of CNF from bagasse pith, which has a soft tissue structure and is rich in parenchyma cells. This scheme expands the utilization path of sugar waste sucrose pulp. The effect of NaOH, O2, macromolecular carbohydrates, and lignin on subsequent ultrasonic etching was analyzed, and it was found that the degree of alkali­oxygen cooking was positively correlated with the difficulty of subsequent ultrasonic etching. The mechanism of ultrasonic nano-crystallization was found to be the bidirectional etching mode from the edge and surface cracks of the cell fragments by ultrasonic microjet in the microtopography of CNF. The optimum preparation scheme was obtained under the condition of 28 % NaOH content and 0.5 MPa O2, which solves the problem of low-value utilization of bagasse pith and environmental pollution, providing a new possibility for the source of CNF.

Antibodies against Poly(ethylene glycol) Activate Innate Immune Cells and Induce Hypersensitivity Reactions to PEGylated Nanomedicines.

Nanomedicines and macromolecular drugs can induce hypersensitivity reactions (HSRs) with symptoms ranging from flushing and breathing difficulties to hypothermia, hypotension, and death in the most severe cases. Because many normal individuals have pre-existing antibodies that bind to poly(ethylene glycol) (PEG), which is often present on the surface of nanomedicines and macromolecular drugs, we examined if and how anti-PEG antibodies induce HSRs to PEGylated liposomal doxorubicin (PLD). Anti-PEG IgG but not anti-PEG IgM induced symptoms of HSRs including hypothermia, altered lung function, and hypotension after PLD administration in C57BL/6 and nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mice. Hypothermia was significantly reduced by blocking FcγRII/III, by depleting basophils, monocytes, neutrophils, or mast cells, and by inhibiting secretion of histamine and platelet-activating factor. Anti-PEG IgG also induced hypothermia in mice after administration of other PEGylated liposomes, nanoparticles, or proteins. Humanized anti-PEG IgG promoted binding of PEGylated nanoparticles to human immune cells and induced secretion of histamine from human basophils in the presence of PLD. Anti-PEG IgE could also induce hypersensitivity reactions in mice after administration of PLD. Our results demonstrate an important role for IgG antibodies in induction of HSRs to PEGylated nanomedicines through interaction with Fcγ receptors on innate immune cells and provide a deeper understanding of HSRs to PEGylated nanoparticles and macromolecular drugs that may facilitate development of safer nanomedicines.

Blood uptake and urine excretion of nano- and micro-plastics after a single exposure.

Nano- and micro-plastic (NMP) pollution has emerged as a global issue; however, uptake in the blood is controversial. Also, there is no evidence that NMPs are excreted via urine. This study was designed to clarify the time course of NMPs absorption in blood and the excretion in urine. Male mice received a single administration of fluorescent polystyrene (PS) beads (100-nm and 3-µm) via tail vein injection, gavage, or pulmonary perfusion. Blood and urine samples were measured 0.5, 1, 2, and 4 h after exposure by confocal laser scanning microscope (CLSM). Transmission electron microscopy (TEM) was performed to corroborate the findings. Fluorescence particles were detected in both blood and urine from the 100-nm and 3-µm PS-treated groups after exposure. In the 3-µm PS treated group, particles with corresponding diameters were detected after intravenous injection and pulmonary perfusion, and particles with a diameter <3 µm were detected in blood samples after gavage. The fluorescent signal in urine was particularly weak and the size was <3 µm. Significant time course changes in fluorescence intensity were demonstrated in blood and urine (P < 0.05) after intravenous injection and pulmonary perfusion in the 100-nm PS-treated group. By contrast, significant changes were detected in the urine (P < 0.05), but not the blood, after gavage. TEM confirmed the presence of particles with corresponding diameters in blood samples; however, the excretion in urine was difficult to confirm for nano-plastics (NPs) and micro-plastics (MPs) because all particles with diameters of approximately 100 nm and 3 µm had irregular shapes and no clear boundaries. Our findings revealed that both NPs and MPs enter the blood circulation through digestive and respiratory pathways. Both 100-nm and 3-µm NMPs may be excreted through urine, but further evidence is needed. The physical and chemical properties of MPs may be impacted by digestive processes in vivo.

The photothermal stability of CNFs/ZnAl-LDHs composited films: Influence of the crystal morphology of ZnAl-LDHs.

The existence of hydroxyl and carboxyl groups makes the photothermal stability of cellulose nanofibers (CNFs) poor and thus limits its scale application. This problem could be solved by doping layered double hydroxides (LDHs) nanopowders with opposite charge on the surface of CNFs. This work mainly focused on investigation of the influence of the crystal morphology of the inorganic ultraviolet shielding agent (i.e. ZnAl-LDHs) on the thermal stability of CNFs/ZnAl-LDHs composited films. The results showed that the morphology of LDHs was positively correlated with the photothermal stability of CNFs-based films. Specially, the ZnAl-LDHs with uniform crystal morphology could be prepared by controlling the molar ratio of Zn/Al at 3:1 and thus enhance the photothermal stability of CNFs-based films without any serious light transmittance deteriorating after doping. This work provided a practical and effective way for preparation of photothermal-stable CNFs-based transparent films for industrial application in the fields of photonics and electronics.

Distinct antibacterial activity of a vertically aligned graphene coating against Gram-positive and Gram-negative bacteria.

Graphene-based nanomaterials (GBNs) are known to exhibit biocidal activities, however, the combined effect of GBNs based on physical disruption and oxidative stress on different types of bacteria remain unclear. Here, we use both Gram-negative (Escherichia coli and Salmonella typhimurium) and Gram-positive (Staphylococcus aureus and Staphylococcus epidermidis) bacteria to investigate the antimicrobial properties of vertically and horizontally aligned graphenes grown on semiconductor silicon (Si) and insulator silicon dioxide (SiO2). It is found that the bacteria show different sensitivity to isomeric-structured GBNs. Gram-negative bacteria are more vulnerable to graphene-coated Si substrates than to SiO2, because the less negatively charged membrane enhances the electron transfer effect that extracts the electrons from the microbial membranes, and Gram-positive bacteria seem to show more susceptibility to physical puncturing of vertically aligned graphene than to horizontally aligned graphene due to the nature of the compound and the shape of the membrane structure. Subsequently, the vertically aligned graphene Si substrate (G@V-Si) exerts the superior antimicrobial ability on all the bacteria. Finally, all the above GBNs show low cytotoxicity and high biocompatibility, and the robust in vivo antibacterial effect indicates that G@V-Si could serve as an ideal platform for antimicrobial treatment.

Investigation of biodistribution and tissue penetration of PEGylated gold nanostars and their application for photothermal cancer treatment in tumor-bearing mice.

Gold nanostars (AuNSs), with unique physicochemical properties, are thought to be a promising agent for photothermal therapy (PTT). In this study, we prepared PEGylated gold nanostars (pAuNSs) using the HEPES-reduction method. The high photothermal conversion efficiency (∼80%) and photothermal stability of pAuNSs were demonstrated in vitro and in vivo. 111In-DTPA-pAuNSs were prepared as a radioactive surrogate for the biodistribution studies of pAuNSs. In both microSPECT/CT images and the biodistribution study, the tumor-to-muscle (T/M) ratio reached a maximum at 24 h post intravenous injection of 111In-DTPA-pAuNSs. The high linear correlation between the 111In radioactivity and the gold content in the tumors (R2 0.86-0.99) indicated that 111In-DTPA-pAuNSs were appropriate for noninvasively tracking pAuNSs in vivo after systemic administration. Histological examination after silver enhancement staining clearly illustrated that the accumulated pAuNSs in the tumors were mainly located on the luminal surface of vessels. The mice bearing a SKOV-3 xenograft exhibited remarkable therapeutic efficacy with negligible organ damage after receiving pAuNS-mediated photothermal therapy. Our findings suggested that pAuNSs, together with their radioactive surrogate 111In-DTPA-pAuNSs, are promising for applications in image-guided photothermal therapy.

RhBMP-2 loaded 3D-printed mesoporous silica/calcium phosphate cement porous scaffolds with enhanced vascularization and osteogenesis properties.

A major limitation in the development of effective scaffolds for bone regeneration has been the limited vascularization of the regenerating tissue. Here, we propose the development of a novel calcium phosphate cement (CPC)-based scaffold combining the properties of mesoporous silica (MS) with recombinant human bone morphogenic protein-2 (rhBMP-2) to facilitate vascularization and osteogenesis. Specifically, the development of a custom MS/CPC paste allowed the three-dimensional (3D) printing of scaffolds with a defined macroporous structure and optimized silicon (Si) ions release profile to promote the ingrowth of vascular tissue at an early stage after implantation in support of tissue viability and osteogenesis. In addition, the scaffold microstructure allowed the prolonged release of rhBMP-2, which in turn significantly stimulated the osteogenesis of human bone marrow stromal cells in vitro and of bone regeneration in vivo as shown in a rabbit femur defect repair model. Thus, the combination MS/CPC/rhBMP-2 scaffolds might provide a solution to issues of tissue necrosis during the regeneration process and therefore might be able to be readily developed into a useful tool for bone repair in the clinic.

Influence of the T1-slope on sagittal alignment of the subaxial cervical spine after posterior atlantoaxial fusion in os odontoideum.

OBJECTIVES: To analyze the effect of T1-slope (T1S) on sagittal alignment of the subaxial cervical spine after posterior C1-C2 fusion. PATIENTS AND METHODS: The data of 35 consecutive patients who underwent posterior C1-C2 fusion due to atlantoaxial instability with os odontoideum were retrospectively reviewed. Radiographic parameters, including T1S, C1-C2 angle and C2-C7 angle, were measured before operation and at the final follow-up. Patients were divided into 2 groups: high T1S group and low T1S group. Differences within and between groups in radiographic parameters and the relationships among T1S, C1-C2 angle and C2-C7 angle were analyzed. RESULTS: After operation, C1-C2 angle was significantly enlarged (P<0.05) while C2-C7 angle reduced (P<0.05). However, significant change was not observed in T1S (P>0.05). Postoperative C2-C7 angle had a medium positive relation with both preoperative (r=0.563, P<0.05) and postoperative T1S (r=0.547, P<0.05). C1-C2 angle was negatively related to C2-C7 angle before operation (r=-0.590, P<0.05) but not after operation (r=-0.125, P>0.05). However, change of C1-C2 angle demonstrated a medium negative relation with change of C2-C7 angle after operation (r=-0.614, P<0.05). When the patients were divided into high and low T1S groups, there were significant difference in both preoperative and postoperative C2-C7 angles between 2 groups (all P<0.05) but not in C1-C2 angle, change of C1-C2 angle or change of C2-C7 angle (all P>0.05). After operation, C1-C2 angles became larger in both groups (all P<0.05). Meanwhile, although postoperative C2-C7 angle became smaller than preoperative one in both groups, statistical difference was only observed in high T1S group (P<0.05). CONCLUSION: T1S was a useful parameter to evaluate postoperative alignment of the subaxial cervical spine after posterior C1-C2 fusion. To avoid postoperative misalignment of the subaxial cervical spine, C1-C2 should be fixed in less lordosis, especially in patients with high preoperative T1S.

Comparison of Clinical Outcomes of Posterior C1-C2 Temporary Fixation Without Fusion and C1-C2 Fusion for Fresh Odontoid Fractures.

BACKGROUND: Posterior C1-C2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. However, few studies analyze the difference in clinical outcome between this technique and posterior C1-C2 fusion technique for new odontoid fracture. OBJECTIVE: To verify whether the clinical outcome of the posterior C1-C2 temporary-fixation technique is superior to that of the posterior C1-C2 fusion technique in the treatment of a new odontoid fracture. METHODS: Twenty-one of 22 patients who underwent posterior C1-C2 temporary fixation of an odontoid fracture achieved fracture healing and regained motion of the atlantoaxial joint. The functional outcomes of these 21 patients were compared with that of a control group, which consisted of 21 randomly enrolled cases with posterior C1-C2 fixation and fusion. The differences between the 2 groups in the visual analog scale score for neck pain, neck stiffness, Neck Disability Index, 36-Item Short Form Health Survey, and time to fracture healing were analyzed. RESULTS: Significantly better outcomes were observed in the temporary-fixation group for visual analog scale score for neck pain, Neck Disability Index, and neck stiffness. The outcomes in the temporary-fixation group was superior to those in the fusion group in all dimensions of the 36-Item Short Form Health Survey. There were no significant differences in fracture healing rate and time to fracture healing between the 2 techniques. CONCLUSION: Functional outcomes were significantly better after posterior C1-C2 temporary fixation than after fusion. Temporary fixation can be used as a salvage treatment for an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation.

A New Graphene Derivative: Hydroxylated Graphene with Excellent Biocompatibility.

Graphene derivatives (such as graphene oxide and hydrogenated graphene) have been widely investigated because of their excellent properties. Here, we report large-scale (kilogram scale) synthesis of a new unique graphene derivative: hydroxylated graphene (G-OH). The exclusive existence form of oxygen-containing groups in G-OH is hydroxyl, which was verified by spectral characterization and quantitative halogenating reaction. It is very interesting that both the wettability and electrical conductivity show reversible change in halogenating and hydrolysis reaction cycles, which demonstrates the versatility of G-OH. Most importantly, the hydrophilicity and weak inductive nature of G-OH provides a well microenvironment for the cells adhesion and proliferation. On G-OH paper, rat adipose tissue-derived stromal cells exhibited a typical fibroblast-like shape with high rate of increase and survival after 3 day of incubation. This G-OH paper with good mechanical property is expected to be a new biomaterial for bone, vessel and skin regeneration.

Recycling of asbestos tailings used as reinforcing fillers in polypropylene based composites.

In this work, asbestos tailings were recycled and used as reinforcing fillers to enhance the mechanical properties of polypropylene (PP). A silane coupling agent was used to chemically modify the asbestos tailings to increase the compatibility between asbestos tailings and polypropylene matrix. Both raw and chemically treated asbestos tailings with different loading levels (from 3 to 30 wt%) were utilized to fabricate composites. Mechanical properties of these composites have been investigated by dynamic mechanical analysis, tensile test and notched impact test. Results showed that hybridization of asbestos tailings in the composites enhanced the mechanical properties of neat PP evidently, and treated asbestos tailings/PP composites yielded even better mechanical properties compared with those of raw asbestos tailings/PP composites. This recycling method of asbestos tailings not only reduces disposal costs and avoids secondary pollution but also produces a new PP-based composite material with enhanced mechanical properties.

Orbital wall repair in canines with beta-tricalcium phosphate and induced bone marrow stromal cells.

Bone tissue engineering is a new approach for the repair of orbital defects. The aim of the present study was to evaluate prefabricated beta-tricalcium phosphate (ß-TCP) combined with autologous bone marrow stromal cells (BMSCs) to repair orbital wall defect in canine models. Defects measuring 10 mm in diameter were created in the orbital medial walls of 12 dogs. The orbits were randomly divided into five groups: group 1, repaired with osteogenesis-induced BMSCs/TCP constructs; group 2, repaired with noninduced BMSCs/TCP constructs; group 3, repaired with ß-TCP scaffolds only; group 4, normal group; group 5, negative control (bone defect without treatment). Computed tomography (CT) scanning, gross observation, bone density measurements, micro-CT, and histological observations were performed. In group 1, new bone was observed with only a small amount of residual material, and bony union was achieved 3 months after surgery. In contrast, the constructs showed slow degradation with minimal bone formation in groups 2 and 3. Furthermore, the appearance and bone density of the constructs in group 1 were similar to that of normal bone: the constructs were covered with complete mucosa, and new alveolate plate grew into the ethmoidal sinuses. A large bone defect remained in group 5. This study demonstrated that biologic scaffolds composed of ß-TCP and osteogenesis-induced BMSCs have been successfully used to restore bone functionality in animal models, which may provide a potential clinical approach for orbital wall repair and bone regeneration in humans.