A double-suture cerclage reduction technique with Nice knots for comminuted patella fractures (AO/OTA 34-C3).

BACKGROUND: Comminuted patella fractures place high demands on surgeons' surgical skills. We used a double-suture cerclage reduction with Nice knots as an intra-operative reduction technique to displaced comminuted patella fractures. METHODS: Patients were divided into two groups by whether or not an intra-operative suture cerclage reduction technique was used. Fragments count, surgical time, quality of the reduction, and fracture healing time were recorded. The postoperative function was assessed by Böstman score and range of motion. RESULTS: With the inclusion and exclusion criteria, 48 patients we included in the cohort between Sept. 2016 and Oct. 2021. The double-suture cerclage reduction technique with a Nice knot achieved a satisfactory reduction. When the number of fragments was over 5, this technique showed significant advantages in saving surgery time. CONCLUSIONS: In this study, the double-suture cerclage reduction technique combined with the Nice knot shows significant advantages for displaced highly comminuted patella fractures. This technique simplifies the operation and saves surgical time, which is helpful for clinical practice.

A prospective cohort study: platelet-rich plasma combined with carpal tunnel release treating carpal tunnel syndrome.

BACKGROUND: PRP injection was proved to promote the health condition of individuals with mild to moderate Carpal Tunnel Syndrome (CTS). However, carpal tunnel release (CTR) was still a necessary treatment for individuals with moderate and severe CTS. METHODS: To explore whether adjuvant PRP treatment would improve the prognosis while using CTR, we included 82 patients in this study. Preoperative and postoperative visual analog scale (VAS), Boston carpal tunnel syndrome questionnaire-symptom severity scale (BCTQ-SSS), Boston carpal tunnel syndrome questionnaire-functional status scale (BCTQ-FSS), and grip strength were used to examine the patient's symptoms and function. RESULTS: CTR combined with PRP treatment improved the VAS (1.9 ± 0.5 versus 1.4 ± 0.4, P < .05), BCTQ-SSS (1.8 ± 0.4versus 1.5 ± 0.3, P < .05) and BCTQ-FSS (1.8 ± 0.5 versus 1.4 ± 0.6, P < .05) in patients with moderate symptoms within one month after surgery. At the same time, it does not show any advantages in treating individuals with severe carpal tunnel syndrome. CONCLUSIONS: PRP does not affect long-term prognosis while increasing the surgery cost. To conclude, PRP as an adjuvant treatment of CTR has limited effect. Considering the additional financial burden on patients, CTR combined with PRP should be cautious in CTS treatment.

Retraction Notice to: Silencing of the MEKK2/MEKK3 Pathway Protects against Spinal Cord Injury via the Hedgehog Pathway and the JNK Pathway.

[This retracts the article DOI: 10.1016/j.omtn.2019.05.014.].

NIR-II Ratiometric Lanthanide-Dye Hybrid Nanoprobes Doped Bioscaffolds for In Situ Bone Repair Monitoring.

In situ monitoring of tissue regeneration progression is of primary importance to basic medical research and clinical transformation. Despite significant progress in the field of tissue engineering and regenerative medicine, few technologies have been established to in situ inspect the regenerative process. Here, we present an integrated second near-infrared (NIR-II, 1000-1700 nm) window in vivo imaging strategy based on 3D-printed bioactive glass scaffolds doped with NIR-II ratiometric lanthanide-dye hybrid nanoprobes, allowing for in situ monitoring of the early inflammation, angiogenesis, and implant degradation during mouse skull repair. The functional bioactive glass scaffolds contribute to more effective bone regeneration because of their excellent angiogenic and osteogenic activities. The reliability of ratiometric fluorescence imaging, coupled with low autofluoresence in the NIR-II window, facilitates the accuracy of in vivo inflammation detection and high-resolution visualization of neovascularization and implant degradation in deep tissue.

Development of a novel RNAi therapy: Engineered miR-31 exosomes promoted the healing of diabetic wounds.

RATIONALE: Chronic wounds associated with diabetes exact a heavy burden on individuals and society and do not have a specific treatment. Exosome therapy is an extension of stem cell therapy, and RNA interference (RNAi)-based therapy is a type of advanced precision therapy. Based on the discovery of chronic wound-related genes in diabetes, we combined exosome therapy and RNAi therapy through an engineering approach for the treatment of diabetic chronic wounds. METHODS: We combined exosome therapy and RNAi therapy to establish a precision therapy for diabetes-associated wounds via an engineered exosome approach. RESULTS: First, chronic diabetic wounds express low levels of miR-31-5p compared with nondiabetic wounds, and an miR-31-5p mimic was shown to be effective in promoting the proliferation and migration of three wound-related cell types in vitro. Second, bioinformatics analysis, luciferase reporter assays and western blotting suggested that miR-31-5p promoted angiogenesis, fibrogenesis and reepithelization by inhibiting factor-inhibiting HIF-1 (HIF1AN, also named FIH) and epithelial membrane protein-1 (EMP-1). Third, engineered miR-31 exosomes were generated as a miR-31-5p RNAi therapeutic agent. In vivo, the engineered miR-31 exosomes promoted diabetic wound healing by enhancing angiogenesis, fibrogenesis and reepithelization. CONCLUSION: Engineered miR-31 exosomes are an ideal disease pathophysiology-initiated RNAi therapeutic agent for diabetic wounds.

Sequential Release of Small Extracellular Vesicles from Bilayered Thiolated Alginate/Polyethylene Glycol Diacrylate Hydrogels for Scarless Wound Healing.

Excessive scar formation has adverse physiological and psychological effects on patients; therefore, a therapeutic strategy for rapid wound healing and reduced scar formation is urgently needed. Herein, bilayered thiolated alginate/PEG diacrylate (BSSPD) hydrogels were fabricated for sequential release of small extracellular vesicles (sEVs), which acted in different wound healing phases, to achieve rapid and scarless wound healing. The sEVs secreted by bone marrow derived mesenchymal stem cells (B-sEVs) were released from the lower layer of the hydrogels to promote angiogenesis and collagen deposition by accelerating fibroblast and endothelial cell proliferation and migration during the early inflammation and proliferation phases, while sEVs secreted by miR-29b-3p-enriched bone marrow derived mesenchymal stem cells were released from the upper layer of the hydrogels and suppressed excessive capillary proliferation and collagen deposition during the late proliferation and maturation phases. In a full-thickness skin defect model of rats and rabbit ears, the wound repair rate, angiogenesis, and collagen deposition were evaluated at different time points after treatment with BSSPD loaded with B-sEVs. Interestingly, during the end of the maturation phase in the in vivo model, tissues in the groups treated with BSSPD loaded with sEVs for sequential release (SR-sEVs@BSSPD) exhibited a more uniform vascular structure distribution, more regular collagen arrangement, and lower volume of hyperplastic scar tissue than tissues in the other groups. Hence, SR-sEVs@BSSPD based on skin repair phases was successfully designed and has considerable potential as a cell-free therapy for scarless wound healing.

miR-23a-3p-abundant small extracellular vesicles released from Gelma/nanoclay hydrogel for cartilage regeneration.

Articular cartilage has limited self-regenerative capacity and the therapeutic methods for cartilage defects are still dissatisfactory in clinic. Recent studies showed that exosomes derived from mesenchymal stem cells promoted chondrogenesis by delivering bioactive substances to the recipient cells, indicating exosomes might be a novel method for repairing cartilage defect. Herein, we investigated the role and mechanism of human umbilical cord mesenchymal stem cells derived small extracellular vesicles (hUC-MSCs-sEVs) on cartilage regeneration. In vitro results showed that hUC-MSCs-sEVs promoted the migration, proliferation and differentiation of chondrocytes and human bone marrow mesenchymal stem cells (hBMSCs). MiRNA microarray showed that miR-23a-3p was the most highly expressed among the various miRNAs contained in hUC-MSCs-sEVs. Our data revealed that hUC-MSCs-sEVs promoted cartilage regeneration by transferring miR-23a-3p to suppress the level of PTEN and elevate expression of AKT. Moreover, we fabricated Gelatin methacrylate (Gelma)/nanoclay hydrogel (Gel-nano) for sustained release of sEVs, which was biocompatible and exhibited excellent mechanical property. In vivo results showed that hUC-MSCs-sEVs containing Gelma/nanoclay hydrogel (Gel-nano-sEVs) effectively promoted cartilage regeneration. These results indicated that Gel-nano-sEVs have a promising capacity to stimulate chondrogenesis and heal cartilage defects, and also provided valuable data for understanding the role and mechanism of hUC-MSCs-sEVs in cartilage regeneration.

Friction stability and cellular behaviors on laser textured Ti-6Al-4V alloy implants with bioinspired micro-overlapping structures.

The grain structure and surface morphology of bio-implants act as a pivotal part in altering cell behavior. Titanium alloy bone screws, as common implants, are prone to screws loosening and complications threat in the physiological environment due to their inferior anti-wear and surface inertia. Manufacturing bone screws with high wear resistance and ideal biocompatibility has always been a challenge. In this study, a series of overlapping morphologies inspired by the hierarchical structure of fish scales and micro bulges of shrimp were structured on Ti-6Al-4V implant by laser texturing. The results indicate that the textured patterns could improve cell attachment, proliferation, and osteogenic differentiation. The short-term response of human bone marrow-derived mesenchymal stem cells (hBMSCs) on the textured surface are more sensitive to the microstructure than the surface roughness, wettability, grain size and surface chemical elements of the textured surfaces. More importantly, the friction-increasing and friction-reducing type overlapping structures exhibit excellent friction stability at different stages of modified simulated body fluid (m-SBF) soaking. The overlapping structure (Micro-smooth stacked ring: MSSR) is more beneficial to promote the formation of apatite. Deposited spherical-like apatite particles can act as a "lubricant" on the MSSR surface during the friction process to alleviate the adhesion wear of the surface. Meanwhile, apatite particles participate in the formation of friction film, which plays an effective role in reducing friction and antiwear in corrosion solution (m-SBF) for a long time. These features show that the combination of soaking treatment in m-SBF solution with laser-textured MSSR structure is expected to be an efficient and environmentally friendly strategy to prolong the service life of bone screws and reducing the complications of mildly osteoporotic implants.

Organic NIR-II molecule with long blood half-life for in vivo dynamic vascular imaging.

Real-time monitoring of vessel dysfunction is of great significance in preclinical research. Optical bioimaging in the second near-infrared (NIR-II) window provides advantages including high resolution and fast feedback. However, the reported molecular dyes are hampered by limited blood circulation time (~ 5-60 min) and short absorption and emission wavelength, which impede the accurate long-term monitoring. Here, we report a NIR-II molecule (LZ-1105) with absorption and emission beyond 1000 nm. Thanks to the long blood circulation time (half-life of 3.2 h), the fluorophore is used for continuous real-time monitoring of dynamic vascular processes, including ischemic reperfusion in hindlimbs, thrombolysis in carotid artery and opening and recovery of the blood brain barrier (BBB). LZ-1105 provides an approach for researchers to assess vessel dysfunction due to the long excitation and emission wavelength and long-term blood circulation properties.

Effect of Surgical Intervention on Neurologic Recovery in Patients with Central Cord Syndrome.

To review the experience of managing central cord syndrome (CCS) surgically, we retrospectively reviewed 71 patients from October 2015 to April 2017. Deteriorating neurologic status with evidence of radiologic compression and spinal instability were absolute indications for surgery. The American Spinal and Injury Association (ASIA) motor scores (AMS) were recorded at the time of admission (aAMS), 3 days postoperatively (3dAMS), 1 month postoperatively(1mAMS), and at final follow-up (fAMS). Analysis of variance was performed to compare 3dAMS, 1mAMS, and fAMS. Surgery was successful in all 71 patients without re-injury of the spinal cord, infection, or other perioperative complications. The postoperative AMS at 3 days, 1 month, and at the final follow-up significantly improved over preoperative scores. ASIA sensory scores at fAMS were significantly better than 3dAMS and1mAMS scores. The ASIA motor and sensory scores at 1mAMS showed no significant improvements compared with the 3dAMS. Therefore, for patients diagnosed with CCS, combined with evidence of radiologic compression and spinal instability, surgery was beneficial in terms of gains in neurologic recovery.

Biofunctionalized chondrogenic shape-memory ternary scaffolds for efficient cell-free cartilage regeneration.

Cartilage defect repair remains a great clinical challenge due to the limited self-regeneration capacity of cartilage tissue. Surgical treatment of injured cartilage is rather difficult due to the narrow space in the articular cavity and irregular defect area. Herein, we designed and fabricated chondrogenic and physiological-temperature-triggered shape-memory ternary scaffolds for cell-free cartilage repair, where the poly (glycerol sebacate) (PGS) networks ensured elasticity and shape recovery, crystallized poly (1,3-propylene sebacate) (PPS) acted as switchable phase, and immobilized bioactive kartogenin (KGN) endowed the scaffolds with chondrogenic capacity. The resultant scaffolds exhibited shape-memory properties with shape-memory fixed ratio of 98% and recovered ratio of 97% at 37°C for PPS/PGS/KGN-100, indicating a good potential for minimally invasive implantation. The scaffolds gradually degraded in Dulbecco's phosphate-buffered saline and released KGN up to 12 weeks in vitro. In addition, the scaffolds promoted chondrogenic differentiation while inhibiting osteogenic differentiation of bone marrow-derived mesenchymal stem cells in a concentration-dependent manner and cartilage regeneration in full-thickness defects of rat femoropatellar groove for 12 weeks. Consequently, the PPS/PGS/KGN-100 scaffolds stimulated the formation of an overlying layer of neocartilage mimicking the characteristic architecture of native articular cartilage even in the absence of exogenous growth factors and seeded cells. This study provides much inspiration for future research on cartilage tissue engineering. STATEMENT OF SIGNIFICANCE: There are two crucial challenges for cartilage defect repair: the lack of self-regeneration capacity of cartilage tissue and difficult scaffold implantation via traditional open surgery due to space-limited joints. Herein, bioactive body-temperature-responsive shape memory scaffolds are designed to simultaneously address the challenges. The scaffolds can be readily implanted by minimally invasive approach and recover by body-temperature of patient. The integration of kartogenin endows scaffolds the bioactivity, leading to the first example of bulk shape-memory scaffolds for cell-free cartilage repair. These characteristics make the scaffolds advantageous for clinical translation. Moreover, our developed material is easy to be functionalized due to the presence of extensive free hydroxyl groups and provides a versatile platform to design diverse functional shape memory biomaterials.

WITHDRAWN: Endothelial progenitor cells deliver exogenous miR-126 via exosomes to accelerate wound healing in diabetes mellitus.

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Enhanced Osseointegration of Titanium Alloy Implants with Laser Microgrooved Surfaces and Graphene Oxide Coating.

Rapid and effective osseointegration, as a critical factor in affecting the success rate of titanium (Ti) implants in orthopedic applications, is significantly affected by their surface microstructure and chemical composition. In this work, surface microgrooved Ti-6Al-4V alloys with graphene oxide coating (Ti-G-GO) were fabricated by a combination of laser processing and chemical assembly techniques. The osteogenic capability in vitro and new bone formation in vivo of the implants were systematically investigated, and biomechanical pull-out tests of the screws were also performed. First, in vitro studies indicated that the optimal microgroove width of the titanium alloy surface was 45 µm (Ti-G), and the optimum GO concentration was 1 mg/mL. Furthermore, the effects of the surface microstructure and GO coating on the in vitro bioactivity were investigated through culturing bone marrow mesenchymal stem cells (BMSCs) on the surface of titanium alloy plates. The results showed that the BMSCs cultured on the Ti-G-GO group exhibited the best adhesion, proliferation, and differentiation, compared with that on the Ti-G and Ti groups. Micro-computed tomography evaluation, histological analysis, and pull-out testing demonstrated that both Ti-G and Ti-G-GO implants had the higher osseointegration than the untreated Ti implant. Moreover, the osteogenic capability of the Ti-G-GO group appeared to be superior to that of the Ti-G group, which could be attributed to the improvement of surface wettability and apatite formation by the GO coatings. These results suggest that the combination of the microgroove structure and GO coatings exhibits considerable potential for enhancing the surface bioactivation of materials, and the combination modification is expected to be used on engineered titanium alloy surfaces to enhance osseointegration for orthopedic applications.

Silencing of the MEKK2/MEKK3 Pathway Protects against Spinal Cord Injury via the Hedgehog Pathway and the JNK Pathway.

Spinal cord injury (SCI) is a devastating medical condition, often accompanied by motor and sensory dysfunction. The Hedgehog (Hh) pathway has a protective role in pathological injury after SCI. However, the specific mechanism remains unclear. The present study aimed to confirm the effects of the mitogen-activated protein kinase kinase-2 (MEKK2)/MEKK3/JNK/Hh pathway on SCI. SCI rat models were established and then inoculated with plasmids overexpressing MEKK2/MEKK3 or with small interfering RNA (siRNA) against MEKK2/MEKK3. The expression of MEKK2 and -3 was detected in dorsal root ganglia (DRG) cells. The motor function of hindlimbs, the expression of the c-Jun N-terminal kinase (JNK)- and Hh-pathway-related genes, and the level of neurofilament-200 (NF-200) and glial fibrillary acidic protein (GFAP) were measured. MEKK2 and -3 were expressed at a high level in DRG cells. The silencing of MEKK2/MEKK3 in rats caused an increase in the expression of glioma-associated oncogene homolog-1 (Gli-1), Nestin, smoothened (Smo), and Sonic Hedgehog (Shh). The Basso, Beattie, and Bresnahan (BBB) rating and the level of NF-200 protein also increased. However, the expression of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1ß (MIP-1ß), MIP-3α, p-JNK/JNK, and p-c-Jun/c-Jun and the level of GFAP were reduced. Downregulation of MEKK2/MEKK3 ameliorated the symptoms of SCI by promoting neural progenitor cell differentiation via activating the Hh pathway and disrupting the JNK pathway. The findings in this study reveal a potential biomarker for SCI treatment.

Data set for determination of lubrication film thickness and lubrication state between bone and Ti-6Al-4V interface under three biolubrications.

The lubrication states between the friction pairs in lubrications have an important effect on its tribological behavior. Therefore, the aim of this complementary data article is to identify the corresponding lubrication states between bone and Ti-6Al-4V interface in three biolubricants in reciprocation sliding by the Stribeck theory. Among that, three biolubricated film thicknesses at the stroke center and stroke end were separately calculated using the elastohydrodynamic theory. The current data are considered as a complementary for the main work "Tribological behavior of Ti-6Al-4V against cortical bone in different biolubricants" (Wang et al., 2018).

Tribological behavior of Ti-6Al-4V against cortical bone in different biolubricants.

Titanium alloys (Ti-6Al-4V) are promising materials as bone implants in clinical surgeries owing to their excellent performances. However, wear debris caused by the tribological behavior of the cortical bone and titanium alloy interface were found to be paramount for implant stability. The contact environment between the cortical bone and Ti-6Al-4V in vivo has been considered to affect the tribological behavior. Currently, the tribological behaviors of bone and Ti-6Al-4V in different biolubricants remain elusive. Therefore, in this work, the tribological behaviors of Ti-6Al-4V plates sliding against bovine cortical bone were investigated in dry sliding and in biolubricants of physiological saline (PS), simulated body fluids (SBF), and fetal bovine serum (FBS). Results show that the friction coefficient and wear rate of the bovine cortical bone and Ti-6Al-4V interface exhibit the same sequence as follows: FBS > SBF > PS > dry sliding. These results are attributed to bone hardness variation and corrosion of different biolubricants. Meanwhile, the effects of normal load and velocity on the tribological behavior of bone and Ti-6Al-4V interface were also investigated in dry sliding and three different biolubricants. Results show that as the normal load is increased and the sliding velocity is decreased, the friction coefficient decreases in dry condition, adhering to the Hertz contact theory. However, according to the boundary lubrication theory, the friction coefficient in three biolubricants correlates positively to the normal load and negatively to the sliding velocity. Moreover, the wear rates of the bone samples increase with the increase in normal load and sliding velocity under dry and biolubrication conditions. Finally, the characterization results indicate that the wear mechanisms of the cortical bone and Ti-6Al-4V interface in dry friction are primarily adhesive and abrasive wear. Further, corrosive wear occurs in biolubrications, apart from adhesive and abrasive wear.

3D printed porous ß-Ca2SiO4 scaffolds derived from preceramic resin and their physicochemical and biological properties.

Silicate bioceramic scaffolds are of great interest in bone tissue engineering, but the fabrication of silicate bioceramic scaffolds with complex geometries is still challenging. In this study, three-dimensional (3D) porous ß-Ca2SiO4 scaffolds have been successfully fabricated from preceramic resin loaded with CaCO3 active filler by 3D printing. The fabricated ß-Ca2SiO4 scaffolds had uniform interconnected macropores (ca. 400 µm), high porosity (>78%), enhanced mechanical strength (ca. 5.2 MPa), and excellent apatite mineralization ability. Importantly, the results showed that the increase of sintering temperature significantly enhanced the compressive strength and the scaffolds sintered at higher sintering temperature stimulated the adhesion, proliferation, alkaline phosphatase activity, and osteogenic-related gene expression of rat bone mesenchymal stem cells. Therefore, the 3D printed ß-Ca2SiO4 scaffolds derived from preceramic resin and CaCO3 active fillers would be promising candidates for bone tissue engineering.

Mesoporous bioactive glass-coated 3D printed borosilicate bioactive glass scaffolds for improving repair of bone defects.

Background: In the field of tissue engineering, there is currently increasing interest in new biomedical materials with high osteogenic ability and comparable mechanical function to repair bone defects. Three-dimensional (3-D) bioactive borosilicate glass (BG) scaffolds exhibit uniform interconnected macro-pores, high porosity and high compressive strength. In this study, we fabricated 3-D BG scaffolds by the 3D printing technique, then coated the surface of the 3-D BG scaffolds with mesoporous bioactive glass (MBG) (BG-MBG scaffold). Methods: The biocompatibility of the BG-MBG scaffolds was evaluated by assessing biodegradability, cell proliferation, alkaline phosphatase (ALP) activity and by quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis of osteogenic gene expression with human bone marrow stromal cells (hBMSCs). Moreover, the BG-MBG scaffolds were used to repair rat femoral defects and their performance was evaluated using microcomputed tomography (micro-CT), fluorescence labeling, histological analysis and immunohistochemical (IHC) analysis. Results: The results showed that the BG-MBG scaffolds possessed ordered nearly 4nm meso-pores and regular macro-pores, as well as good biodegradability, and that they stimulated the proliferation and osteogenic differentiation of hBMSCs. In in vivo studies, the result of micro-CT reconstructed images (BG-9M group, 0.63 ± 0.02 g/cm3 and BG group 0.13 ± 0.02 g/cm3 ) and van Gieson staining (BG-9M groups, 62.67 ± 3.39% and BG group, 12.33 ± 2.58%) showed that the BG-MBG scaffolds could significantly enhance new bone formation in both inner and peripheral scaffolds in defects, in and in without the presence of growth factors or stem cells (P < 0.05). Conclusions: It is believed from these results that the BG-MBG scaffolds possess excellent osteoinductive and osteogenic properties which will make them appealing candidates for bone defect repair. The novelty of our research is to provide a new material to treat bone defects in clinic.

Composite-dissolving microneedle patches for chemotherapy and photothermal therapy in superficial tumor treatment.

A combination of chemotherapy and photothermal therapy (PTT) has emerged as a promising strategy for cancer therapy. To ensure that the chemotherapeutic drug and photothermal agent can be simultaneously delivered to the tumor site to exert their synergistic effects, a safe and efficient delivery system is needed. Herein, we fabricated doxorubicin hydrochloride (DOX)- and indocyanine green (ICG)-loaded microneedle (MN) patches (PVP@DOX/MSN@ICG) using a two-step casting process. Mesoporous silica nanoparticles (MSNs) were used to improve the ICG stability and avoid reducing its PTT efficiency in vivo. The MN patches exhibited a good skin penetration ability, and the tips of the MN patches were dissolved by the interstitial fluid to release DOX and ICG at the tumor sites. Under 808 nm laser irradiation within 2 min, the local temperature in the tumor quickly reached 48 °C at a low power of 0.34 W cm-2. A combination of chemotherapy and PTT for PVP@DOX/MSN@ICG MN patches may maximally induce human osteosarcoma MG-63 cells in vitro. Moreover, the in vivo results showed that PVP@DOX/MSN@ICG MN patches had the best antitumor effects because of synergistic chemotherapy and PTT. Therefore, the composite-dissolving MN patch is a promising strategy for enhancing the antitumor effect of chemotherapy alone and shows the potential for the synergistic therapy of superficial tumors.