Analysis of microbiological tests in patients withholding or withdrawing life-sustaining treatment at the end stage of life in 2 Korean hospitals.

OBJECTIVE: We evaluated the adequacy of microbiological tests in patients withholding or withdrawing life-sustaining treatment (WLST) at the end stage of life. SETTING: The study was conducted at 2 tertiary-care referral hospitals in Daegu, Republic of Korea. DESIGN: Retrospective cross-sectional study. METHODS: Demographic findings, clinical and epidemiological characteristics, statistics of microbiological tests, and microbial species isolated from patients within 2 weeks before death were collected in 2 tertiary-care referral hospitals from January to December 2018. We also reviewed the antimicrobial treatment that was given within 3 days of microbiological testing in patients on WLST. RESULTS: Of the 1,187 hospitalized patients included, 905 patients (76.2%) had WLST. The number of tests per 1,000 patient days was higher after WLST than before WLST (242.0 vs 202.4). Among the category of microbiological tests, blood cultures were performed most frequently, and their numbers per 1,000 patient days before and after WLST were 95.9 and 99.0, respectively. The positive rates of blood culture before and after WLST were 17.2% and 18.0%, respectively. Candida spp. were the most common microbiological species in sputum (17.4%) and urine (48.2%), and Acinetobacter spp. were the most common in blood culture (17.3%). After WLST determination, 70.5% of microbiological tests did not lead to a change in antibiotic use. CONCLUSIONS: Many unnecessary microbiological tests are being performed in patients with WLST within 2 weeks of death. Microbiological testing should be performed carefully and in accordance with the patient's treatment goals.

Development of Gelatin Methacryloyl/Sodium Alginate Interpenetrating Polymer Network Hydrogels for Bone Regeneration by Activating the Wnt/ß-Catenin Signaling Pathway via Lithium Release.

Hydrogels have gained significant attention as biomaterials due to their remarkable properties resembling those of the extracellular matrix (ECM). In the present investigation, we successfully synthesized interpenetrating polymer network (IPN) hydrogels using gelatin methacryloyl (GelMA) and sodium alginate (SA), incorporating various concentrations of lithium chloride (LiCl; 0, 5, and 10 mM), aiming to develop a hydrogel scaffold for bone regeneration. Notably, the compressive modulus of the IPN hydrogels remained largely unaffected upon the inclusion of LiCl. However, the hydrogel with the high concentration of LiCl exhibited reduced fragmentation after compression testing. Intriguingly, we observed a significant improvement in cellular biocompatibility, primarily attributed to activation of the Wnt/ß-catenin signaling pathway induced by LiCl. Subsequently, we evaluated the efficacy of the newly developed IPN-Li hydrogels in a rat cranial defect model and found that they substantially enhanced bone regeneration. Nevertheless, it is important to note that the introduction of high concentrations of LiCl did not significantly promote osteogenesis. This outcome can be attributed to the excessive release of Li+ ions into the extracellular matrix, hindering the desired effect. Overall, the IPN-Li hydrogel developed in this study holds great promise as a biodegradable material for bone regeneration applications.

Biocompatibility and Antibacterial Effect of Ginger Fraction Loaded PLGA Microspheres Fabricated by Coaxial Electrospray.

Various poly(lactic-co-glycolic acid) (PLGA) microspheres loaded with the ginger fraction were fabricated by controlling the electrospray parameters and their biocompatibility and antibacterial activity were identified in this study. The morphology of the microspheres was observed using scanning electron microscopy. The core-shell structures of the microparticles and the presence of ginger fraction in the microspheres were confirmed by fluorescence analysis using a confocal laser scanning microscopy system. In addition, the biocompatibility and antibacterial activity of PLGA microspheres loaded with ginger fraction were evaluated through a cytotoxicity test using osteoblast MC3T3-E1 cells and an antibacterial test using Streptococcus mutans and Streptococcus sanguinis, respectively. The optimum PLGA microspheres loaded with ginger fraction were fabricated under electrospray operational conditions with 3% PLGA concentration in solution, an applied voltage of 15.5 kV, a flow rate of 15 µL/min in the shell nozzle, and 3 µL/min in the core nozzle. The effectual antibacterial effect and enhanced biocompatibility were identified when a 3% ginger fraction in PLGA microspheres was loaded.

Comparative Osteogenesis and Degradation Behavior of Magnesium Implant in Epiphysis and Diaphysis of the Long Bone in the Rat Model.

Magnesium (Mg), as a biodegradable material, is a promising candidate for orthopedic surgery. Long-bone fractures usually occur in cancellous-bone-rich epiphysis at each end or the cortical-rich diaphysis in the center, with different bone healing processes. Little is known about the differences in results between the two regions when applying Mg implants. Therefore, this study aimed to compare the biodegradation and osteogenesis of Mg implants in a rat model's epiphysis and diaphysis of the long bone. Twelve male Sprague Dawley rats underwent Mg rod implantation in the distal femoral epiphyses and tibial diaphyses. Every three weeks for up to twelve weeks, degradation behavior, gas evolution, and new bone formation were measured by micro CT. Histomorphology was analyzed by Hematoxylin and Eosin, Villanueva bone staining, and TRAP staining for osteoclastogenesis evaluations. Micro-CT analysis showed statistically significant higher new bone formation in the epiphysis group than in the diaphysis group, which correlated with a lower gas volume. Histological analysis showed higher osseointegration of Mg implants in the epiphyseal region than in the diaphyseal region. The magnesium implant's osteoclastogenesis-inhibiting properties were shown in the surrounding areas in both the cortical bone of the diaphysis and the cancellous bone of the epiphysis. Our findings show the differences in the magnesium implant's osteogenesis and biodegradation in the epiphysis and the diaphysis. These dissimilarities indicate a better response of the epiphyseal region to the Mg implants, a promising biomaterial for orthopedic surgery applications.

Enhancement of Biofunctionalization by Loading Manuka Oil on TiO2 Nanotubes.

Metallic implants (mesh) for guided bone regeneration can result in foreign body reactions with surrounding tissues, infection, and inflammatory reactions caused by micro-organisms in the oral cavity after implantation. This study aimed to reduce the possibility of surgical failure caused by microbial infection by loading antibacterial manuka oil in a biocompatible nanostructure surface on Ti and to induce stable bone regeneration in the bone defect. The manuka oil from New Zealand consisted of a rich ß-triketone chemotype, leptospermone, which showed strong inhibitory effects against several bacteria, even at very low oil concentrations. The TiO2 nanotubular layer formed by anodization effectively enhanced the surface hydrophilicity, bioactivity, and fast initial bone regeneration. A concentration of manuka oil in the range of 0.02% to less than 1% can have a synergistic effect on antibacterial activity and excellent biocompatibility. A manuka oil coating (especially with a concentration of 0.5%) on the TiO2 nanotube layer can be expected not only to prevent stenosis of the connective tissue around the mesh and inflammation by microbial infection but also to be effective in stable and rapid bone regeneration.

Characteristics of Biodegradable Gelatin Methacrylate Hydrogel Designed to Improve Osteoinduction and Effect of Additional Binding of Tannic Acid on Hydrogel.

In this study, a hydrogel using single and double crosslinking was prepared using GelMA, a natural polymer, and the effect was evaluated when the double crosslinked hydrogel and tannic acid were treated. The resulting hydrogel was subjected to physicochemical property evaluation, biocompatibility evaluation, and animal testing. The free radicals generated through APS/TEMED have a scaffold form with a porous structure in the hydrogel, and have a more stable structure through photo crosslinking. The double crosslinked hydrogel had improved mechanical strength and better results in cell compatibility tests than the single crosslinked group. Moreover, in the hydrogel transplanted into the femur of a rat, the double crosslinked group showed an osteoinductive response due to the attachment of bone minerals after 4 and 8 weeks, but the single crosslinked group did not show an osteoinductive response due to rapid degradation. Treatment with a high concentration of tannic acid showed significantly improved mechanical strength through H-bonding. However, cell adhesion and proliferation were limited compared to the untreated group due to the limitation of water absorption capacity, and no osteoinduction reaction was observed. As a result, it was confirmed that the treatment of high-concentration tannic acid significantly improved mechanical strength, but it was not a suitable method for improving bone induction due to the limitation of water absorption.

Mammalian and Fish Gelatin Methacryloyl-Alginate Interpenetrating Polymer Network Hydrogels for Tissue Engineering.

Gelatin methacryloyl (GelMA) has been widely studied as a biomaterial for tissue engineering. Most studies focus on mammalian gelatin, but certain factors, such as mammalian diseases and diet restrictions, limit the use of mammalian gelatin. Thus, fish gelatin has received much attention as a substitute material in recent years. To develop a broadly applicable hydrogel with excellent properties, an interpenetrating polymer network (IPN) hydrogel was synthesized, since IPN hydrogels consist of at least two different hydrogel components to combine their advantages. In this study, we prepared GelMA using type A and fish gelatin and then synthesized IPN hydrogels using GelMA with alginate. GelMA single-network hydrogels were used as a control group. The favorable mechanical properties of type A and fish hydrogels improved after the synthesis of the IPN hydrogels. Type A and fish IPN hydrogels showed different mechanical properties (mechanical strength, swelling ratio, and degradation rate) and different cross-sectional morphologies, since the degree of mechanical enhancement in fish IPN hydrogels was less than that in type A; however, the cell biocompatibilities were not significantly different. Therefore, these findings could serve as a reference for future studies when selecting GelMA as a biological material for tissue engineering.

Fabrication and Characterization of Biodegradable Gelatin Methacrylate/Biphasic Calcium Phosphate Composite Hydrogel for Bone Tissue Engineering.

In the field of bone tissue, maintaining adequate mechanical strength and tissue volume is an important part. Recently, biphasic calcium phosphate (BCP) was fabricated to solve the shortcomings of hydroxyapatite (HA) and beta-tricalcium phosphate (ß-TCP), and it is widely studied in the field of bone-tissue engineering. In this study, a composite hydrogel was fabricated by applying BCP to gelatin methacrylate (GelMA). It was tested by using a mechanical tester, to characterize the mechanical properties of the prepared composite hydrogel. The fabricated BCP was analyzed through FTIR and XRD. As a result, a different characteristic pattern from hydroxyapatite (HA) and beta-tricalcium phosphate (ß-TCP) was observed, and it was confirmed that it was successfully bound to the hydrogel. Then, the proliferation and differentiation of preosteoblasts were checked to evaluate cell viability. The analysis results showed high cell viability and relatively high bone differentiation ability in the composite hydrogel to which BCP was applied. These features have been shown to be beneficial for bone regeneration by maintaining the volume and shape of the hydrogel. In addition, hydrogels can be advantageous for clinical use, as they can shape the structure of the material for custom applications.

Stabilized Loading of Hyaluronic Acid-Containing Hydrogels into Magnesium-Based Cannulated Screws.

Cannulated screws have a structure for inserting a guide wire inside them to effectively correct complicated fractures. Magnesium, an absorbable metal used to manufacture cannulated screws, may decompose in the body after a certain period of implantation. The hydrogel formed by hyaluronic acid (HA) and polygalacturonic acid (PGA) has been used into Mg-based cannulated screws to prevent bone resorption owing to the rapid corrosion of Mg with unfavorable mechanical properties and a high ambient pH. In addition, Ca ions were added to the gel for cross-linking the carboxyl groups to modify the gelation rate and physical properties of the gel. The developed hydrogels were injected into the Mg-based cannulated screws, after which they released HA and Ca. The possibility of the application of this system as a cannulated screw was evaluated based on the corrosion resistance, gel degradation rate, HA release, toxicity toward osteocytes, and experiments involving the implantation of the screws into the femurs of rats. Ca ions first bound to PGA and delayed the gelation time and dissolution rate. However, they interfered with HA binding and increased the elution of HA at the beginning of gel degradation. Ca(NO3)2 concentrations higher than 0.01 M and low pH environments inhibited osteoblast differentiation and proliferation, owing to the elution of HA from the hydrogel. On the other hand, when the HA hydrogel with a proper amount of Ca was inserted into a magnesium screw, the degradation of Mg was delayed, and the presence of the gel contributed to new bone formation and osteocyte expansion.

Osteogenic Effect of a Biodegradable BMP-2 Hydrogel Injected into a Cannulated Mg Screw.

Cannulated screws, containing an internal hole for inserting a guide pin, are commonly used in the management of bone fractures. Cannulated Mg screws can be biodegraded easily because their increased surface area including that of the inner hole rapidly reacts with body fluids. To delay biodegradation of cannulated Mg screws and improve bone regeneration, we developed a specific type of screw by injecting it with gelatin hydrogels [10 wt % gelatin(gel) with 0.09 v/v % glutaraldehyde (cross-linker)] containing different concentrations (5, 10, or 25 µg/mL) of bone morphogenic proteins (BMPs). We analyzed the properties and biocompatibility of the screws with and without BMP-2 and found that the release rate of BMP-2 in the hydrogel changed proportionately with the degradation rate of the cross-linked hydrogel. Loading BMP-2 in the hydrogel resulted in sustained release of BMP-2 for 25 to 40 days or more. The degradation rate of BMP-2 hydrogels was inversely proportional to the concentration of BMP-2. The injection of the hydrogels in the cannulated screw delayed biodegradation inside of the screw by simulated body fluid. It also induced uniform corrosion and the precipitation of bioactive compounds onto the surface of the screw. In addition, osteoblast proliferation was very active near the BMP-2 hydrogels, depending on the BMP-2 concentration. The BMP-2 in the hydrogel improved cell differentiation. The cannulated screw injected with 10 µL/mL BMP-2 hydrogel prevented implant biodegradation and enhanced osteoconduction and osteointegration inside and outside the screw. In addition, the properties of BMP-2-loaded hydrogels can be changed by controlling the amount of the cross-linker and protein, which could be useful for tissue regeneration in other fields.

Surface Modification of Pure Magnesium Mesh for Guided Bone Regeneration: In Vivo Evaluation of Rat Calvarial Defect.

Guided bone regeneration is a therapeutic method that uses a barrier membrane to provide space available for new bone formation at sites with insufficient bone volume. Magnesium with excellent biocompatibility and mechanical properties has been considered as a promising biodegradable material for guided bone regeneration; however, the rapid degradation rate in the physiological environment is a problem to be solved. In this study, surface modification of pure magnesium mesh was conducted by plasma electrolytic oxidation and hydrothermal treatment to form a densely protective layer on the Mg substrate. The protective layer mainly consisted of Mg(OH)2 with the amorphous calcium phosphate. Then, weight loss measurement and Micro-CT imaging were performed after an immersion test in a simulated body fluid. The effect of surface modification of the magnesium mesh on the guided bone regeneration was evaluated through an in vivo test using the rat calvarial defect model. The biodegradation of the magnesium mesh was identified to be significantly retarded. Additionally, the surface modification of Mg also can improve the bone volume and bone density of calvarial defect in comparison with that of the pristine Mg mesh.

Radiographic and histologic effects of bone morphogenetic protein-2/hydroxyapatite within bioabsorbable magnesium screws in a rabbit model.

BACKGROUND: Hydrogen gas formed by magnesium (Mg) screw corrosion can accumulate around the implant and create bone cysts, long-term osteolysis lesions, and bone healing delay. Thus, several authors currently do not recommend Mg implants for clinical use. In contrast, bone morphogenetic proteins (BMP)-2 have a very strong osteoinductive activity. The purpose of this study was to evaluate the effect of rhBMP-2/hydroxyapatite (HA) inside specially designed Mg cannulated screws in a rabbit femur model for hydrogen gas formation avoidance. METHODS: Fifteen rabbits underwent randomly different cannulated Mg screw implantation in both distal femora; 30 femora were divided into three groups depending on the materials fill in the cannulated Mg screw: control group (Mg screw with no treatment), HA group (Mg screw with HA), and BMP-2/HA group (Mg screw with a composite BMP-2/HA). Plain radiography, micro-CT, and histological analysis were accomplished, and the ability to release BMP-2 of the screws was evaluated by immersion of both the screw with no treatment and screw with a composite BMP-2/HA into the SBF for up to 7 days. RESULTS: X-ray assessment found the gas shadow around the implant was slightly smaller in the BMP-2/HA group than the HA and control groups at 8 weeks. Micro-CT analysis demonstrated statistically significant higher new bone formation in the BMP-2/HA group than the other groups, respectively, which also correlated with a decreased gas volume. Histological analysis showed higher osteointegration between implants and host femurs in the BMP-2/HA group than the HA and control groups at 12 weeks. CONCLUSIONS: This study indicates that the combination of BMP-2/HA within Mg screws enhances new bone formation and therefore has the potential to decrease the complications of hydrogen gas formation around these implants.

Comparative evaluation of the mechanical properties of CAD/CAM dental blocks.

This study compares the mechanical properties of commercially available CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) millable dental blocks including Vita Enamic, Lava Ultimate, and MAZIC Duro. All the discs were cut in dimension of 1.2 mm in thickness and 12 mm in diameter, ground up to #1200 Sic papers and polished. The biaxial flexure strength of the ceramic discs was measured after thermocycling treatment and the broken surfaces were observed using scanning electron microscopy (SEM). The discs were brushed using a toothbrush testing machine under a 150 g load. Surface roughness and morphology were determined after toothbrushing cycles. Finally, the friction and wear behavior of the materials against an opposing tooth were studied using a reciprocating pin-on-plate test configuration. The vertical loss of dental cusp was measured, and the surface image was examined using field emission scanning electron microscopy (FE-SEM). The biaxial flexural strength data were subjected to Weibull analysis. To compare the significance between the groups, all data were analyzed by one-way analysis (ANOVA). The biaxial flexural strength of the Lava Ultimate and MAZIC Duro materials is significantly higher than that of Vita Enamic. In addition, Lava Ultimate and MAZIC Duro exhibited significantly smoother surfaces than that of Vita Enamic after toothbrushing. Lava Ultimate and MAZIC Duro also showed less wear to the opposing tooth than that of Vita Enamic. In addition, Lava Ultimate possesses more suitable mechanical properties than the Vita Enamic and Mazic Duro for use in oral clinical prosthesis.

Osteogenesis-Related Gene Expression and Guided Bone Regeneration of a Strontium-Doped Calcium-Phosphate-Coated Titanium Mesh.

Guided bone regeneration using a perforated titanium membrane is actively used in oral and orthopedic surgeries to provide space for the subsequent filling of a new bone in the case of bone defects and to achieve proper bone augmentation and reconstruction. The surface modification of a titanium membrane using a strontium-substituted calcium phosphate coating has become a popular trend to provide better bioactivity and biocompatibility on the membrane for improving the bone regeneration because strontium can stimulate not only the differentiation of osteoblasts but also inhibit the differentiation of osteoclasts. The strontium-doped calcium phosphate coating on the titanium mesh was formed by the cyclic precalcification method, and its effects on bone regeneration were evaluated by in vitro analysis of osteogenesis-related gene expression and in vivo evaluation of osteogenesis of the titanium mesh using the rat calvarial defect model in this study. It was identified that the strontium-doped calcium phosphate-treated mesh showed a higher expression of all genes related to osteogenesis in the osteoblast cells and resulted in new bone formation with better osseointegration with the mesh in the rat calvarial defect, in comparison with the results of untreated and calcium phosphate-treated meshes.

Enhancement of bone formation on LBL-coated Mg alloy depending on the different concentration of BMP-2.

To control the bio-absorption rate of Mg alloy and improve its biocompatibility, a BMP-2 of various concentrations (20, 50, and 100 ng/mL) was immobilized in the carrier layer formed by micro-arc oxidation + hydrothermal treatment on the surface of Mg alloy. Their morphological and chemical properties were evaluated by FE-SEM with EDS and XRD. The electrochemical corrosion behavior was examined, and the cytotoxicity was assessed by WST and ALP assay. After in vivo test during 2 and 4 weeks in the rat tibia, histological observation was performed. In the carrier layer, calcium phosphate ceramic and oxide layers (MgO and Mg(OH)2) were formed. The layers enhanced the corrosion resistance. It was maintained even after loading the BMP-2. In the BMP-2-loaded group, the proliferation and differentiation of the osteoblast cells were promoted by the continuous release of the BMP-2. After implantation for 2 weeks, all BMP-2-loaded groups showed better biodegradation rate and osseointegration than the control group. After 4 weeks, the group with 50 ng/mL of BMP-2 exhibited the slowest biodegradation rate of all the BMP-2-loaded groups. This effected on the enhancement of new bone formation and the stable bone growth. Therefore, for the short term of implantation, this double coating method could be applied onto biodegradable Mg metal as an orthopedics and dental implant. For the long term of implantation over 4 weeks, to treat Mg implant with 50 ng/mL of BMP-2 was determined to be optimal.

Improvement of osteogenesis by a uniform PCL coating on a magnesium screw for biodegradable applications.

A polymer coating as polycaprolactone (PCL) is applied to improve the initial corrosion resistance of biodegradable magnesium. In addition, plasma electrolytic oxidation (PEO) is performed to increase adhesion between the polymer and the metal. However, when a complex-shaped material such as a screw is implanted in a bone, the surface coatings are locally damaged, and the protective role of the coating is not sufficiently maintained. In this study, the optimal conditions for producing a polymer coating on a screw were determined by varying the concentration of the PCL and the coating cycles, and were examined in vitro and in vivo. Among various the PCL coating conditions of 2∼6 cycles with 5∼7 wt.% concentrations, the 6 wt.% + 4 cycles group was applied uniformly to the screw thread. In the case of the non-uniform PCL layers, oxides and gases were present between the Mg and the PCL layer because internal magnesium corrosion and the layer peel off. The 6 wt.% + 4 cycles group had a high corrosion resistance due to the low wear on the thread. Denser and thicker bone formed around the PCL-coated screw in rat femur. This difference was due to the high corrosion resistance, which provided sufficient time for bone healing and promoting new bone growth.

In Vitro and In Vivo Characterization of N-Acetyl-L-Cysteine Loaded Beta-Tricalcium Phosphate Scaffolds.

Beta-tricalcium phosphate bioceramics are widely used as bone replacement scaffolds in bone tissue engineering. The purpose of this study is to develop beta-tricalcium phosphate scaffold with the optimum mechanical properties and porosity and to identify the effect of N-acetyl-L-cysteine loaded to beta-tricalcium phosphate scaffold on the enhancement of biocompatibility. The various interconnected porous scaffolds were fabricated using slurries containing various concentrations of beta-tricalcium phosphate and different coating times by replica method using polyurethane foam as a passing material. It was confirmed that the scaffold of 40 w/v% beta-tricalcium phosphate with three coating times had optimum microstructure and mechanical properties for bone tissue engineering application. The various concentration of N-acetyl-L-cysteine was loaded on 40 w/v% beta-tricalcium phosphate scaffold. Scaffold group loaded 5 mM N-acetyl-L-cysteine showed the best viability of MC3T3-E1 preosteoblastic cells in the water-soluble tetrazolium salt assay test.

Gas formation and biological effects of biodegradable magnesium in a preclinical and clinical observation.

Magnesium alloys are biodegradable metals receiving increasing attention, but the clinical applications of these materials are delayed by concerns over the rapid corrosion rate and gas formation. Unlike corrosion, which weakens mechanical properties, the gas formation issue has received little attention. Therefore, we evaluated the gas formation and biological effects for Mg implants through preclinical (immersed in Earle's balanced salt solution and in vivo) and clinical studies. The immersion test examined the gas volume and composition. The in vivo study also examined gas volume and histological analysis. The clinical study examined the gas volume and safety after Mg screw metatarsal fixation. Gas was mainly composed of H2, CO and CO2. Maximum volumes of gas formed after 5 days for in vivo and 7 days in clinical study. Within the clinical examination, two superficial wound complications healed with local wound care. Osteolytic lesions in the surrounding metaphysis of the Mg screw insertion developed in all cases and union occurred at 3 months. Mg implants released gas with variable volumes and composition (H2, CO, and CO2), with no long-term toxic effects on the surrounding tissue. The implants enabled bone healing, although complications of wound breakdown and osteolytic lesions developed.

Enhancing of Osseointegration with Propolis-Loaded TiO2 Nanotubes in Rat Mandible for Dental Implants.

TiO2 nanotubes (TNT) formation is beneficial for improving bone cell-material interaction and drug delivery for Ti dental implants. Among the natural drugs to be installed in TNT, selected propolis has antibacterial and anti-inflammatory properties. It is a resinous natural product which is collected by the honeybees from the various types of plants with their salivary enzymes. This study concludes that TNT loaded with a propolis (PL-TNT-Ti) dental implant has the ability to improve osseointegration. The propolis particles were embedded within the TNT or adhered to the top. In a cytotoxicity test using osteoblast, PL-TNT-Ti group exhibited an increased cell proliferation and differentiation. A Sprague Dawley rat mandibular model was used to evaluate the osseointegration and bone bonding of TNT or PL-TNT-Ti. From the µ-CT and hematoxylin and eosin (HE) histological results after implantation at 1 and 4 weeks to rat mandibular, an increase in the extent of new bone formation and mineral density around the PL-TNT-Ti implant was confirmed. The Masson's trichrome staining showed the expression of well-formed collagenous for bone formation on the PL-TNT-Ti. Immunohistochemistry staining indicate that bone morphogenetic proteins (BMP-2 and BMP-7) around the PL-TNT-Ti increased the expression of collagen fibers and of osteogenic differentiation whereas the expression of inflammatory cytokine such as interleukin-1 beta (IL-1ß) and tumor necrosis factor-alpha (TNF-α) is decreased.

Corrosion resistance and bioactivity enhancement of MAO coated Mg alloy depending on the time of hydrothermal treatment in Ca-EDTA solution.

In this study, a two-step surface treatment was developed to restrain the rapid primary degradation of a biodegradable Mg alloy and to improve their biocompatibility. Micro arc oxidation (MAO) coating was performed in alkaline electrolytes such as 1.0 M NaOH with 0.1 M glycerol and 0.1 M Na3PO4. Hydrothermal treatment was performed in 0.1 M Ca-EDTA (C10H12CaN2Na2O8) and 0.5 M NaOH solution at 90 °C for different times (6, 12, 24, and 48 h). The film morphology and chemical properties were evaluated by XRD and FE-SEM. The electrochemical and corrosion behaviors were examined in the simulated body fluid, and cytotoxicity was assessed using MC3T3-E1 cells. After MAO coating, an oxide layer containing [Formula: see text] formed on the surface. During the hydrothermal treatment in Ca-EDTA solution, calcium phosphate and Mg(OH)2 were produced via a reaction between [Formula: see text] on the surface and Ca2+ in solution. The layer with ceramics and oxides was grown on the surface with increasing hydrothermal treatment time, and improved the surface corrosion resistance. The 24 h hydrothermal-treated group showed the lowest immersion corrosion rate and high cell viability. Therefore, this treatment was the most favorable surface modification for improving the initial corrosion resistance and bioactivity of the biodegradable Mg alloy.