Comparison of corticocancellous bone graft from the anterolateral metaphysis of the distal radius versus iliac crest for the treatment of unstable scaphoid nonunion with humpback deformity.

BACKGROUND: Corticocancellous bone grafting from the iliac crest is acceptable treatment for unstable scaphoid nonunion with a viable proximal pole. However, harvesting graft from the iliac crest is associated with donor site morbidity and the requirement of general anesthesia. Thus, bone grafting from the anterolateral metaphysis of the distal radius (DR) can be a treatment option. However, no study has compared the clinical effect between the two grafting techniques. METHODS: From 2014 to 2019, patients with unstable scaphoid nonunion with humpback deformity underwent corticocancellous bone grafting from the anterolateral metaphysis of the DR (group DR) or iliac crest (group IC). Humpback deformity was determined by evaluating the scapholunate angle (SLA) ≥ 60°, intrascaphoid angle (ISA) ≥ 45°, and radiolunate angle (RLA) ≥ 15° from preoperative radiographs and computed tomography scans. The SLA, ISA, and RLA served to gauge carpal alignment. The operative time, grip strength, active range of motion (ROM), the Modified Mayo Wrist score (MMWS), and Disabilities of Arm, Shoulder, and Hand (DASH) score were assessed postoperatively. RESULTS: Thirty-eight patients qualified for the study (group DR, 15; group IC, 23). Union rates did not differ by patient subset (group DR, 100%; group IC, 95.7%; P = .827), and grip strength, ROM, MWS, and DASH score were similar between groups at the last follow-up. The operative time (minutes) was significantly shorter in group DR (median, 98; quartiles, 80, 114) than in group IC (median, 125; quartiles, 105, 150, P < .001). The ISA, RLA, and SLA improved postoperatively in both groups (P < 0.001). The degree of restoring carpal alignment, as evaluated by SLA, showed superior correction capability in group DR (median, 25.3% quartiles, 21.1, 35.3, P < 0.05). Donor site complications were not significantly different between the groups. CONCLUSIONS: Corticocancellous bone graft from the anterolateral metaphysis of the DR for unstable scaphoid nonunion is associated with a shorter operation time and comparable results with that from the iliac crest in regard to union, restoration of carpal alignment, and wrist function. LEVEL OF EVIDENCE: Level III.

Spatially controlled construction of assembloids using bioprinting.

The biofabrication of three-dimensional (3D) tissues that recapitulate organ-specific architecture and function would benefit from temporal and spatial control of cell-cell interactions. Bioprinting, while potentially capable of achieving such control, is poorly suited to organoids with conserved cytoarchitectures that are susceptible to plastic deformation. Here, we develop a platform, termed Spatially Patterned Organoid Transfer (SPOT), consisting of an iron-oxide nanoparticle laden hydrogel and magnetized 3D printer to enable the controlled lifting, transport, and deposition of organoids. We identify cellulose nanofibers as both an ideal biomaterial for encasing organoids with magnetic nanoparticles and a shear-thinning, self-healing support hydrogel for maintaining the spatial positioning of organoids to facilitate the generation of assembloids. We leverage SPOT to create precisely arranged assembloids composed of human pluripotent stem cell-derived neural organoids and patient-derived glioma organoids. In doing so, we demonstrate the potential for the SPOT platform to construct assembloids which recapitulate key developmental processes and disease etiologies.

Gelation of Uniform Interfacial Diffusant in Embedded 3D Printing.

While the human body has many different examples of perfusable structures with complex geometries, biofabrication methods to replicate this complexity are still lacking. Specifically, the fabrication of self-supporting, branched networks with multiple channel diameters is particularly challenging. Here, we present the Gelation of Uniform Interfacial Diffusant in Embedded 3D Printing (GUIDE-3DP) approach for constructing perfusable networks of interconnected channels with precise control over branching geometries and vessel sizes. To achieve user-specified channel dimensions, this technique leverages the predictable diffusion of crosslinking reaction-initiators released from sacrificial inks printed within a hydrogel precursor. We demonstrate the versatility of GUIDE-3DP to be adapted for use with diverse physiochemical crosslinking mechanisms by designing seven printable material systems. Importantly, GUIDE-3DP allows for the independent tunability of both the inner and outer diameters of the printed channels and the ability to fabricate seamless junctions at branch points. This 3D bioprinting platform is uniquely suited for fabricating lumenized structures with complex shapes characteristic of multiple hollow vessels throughout the body. As an exemplary application, we demonstrate the fabrication of vasculature-like networks lined with endothelial cells. GUIDE-3DP represents an important advance toward the fabrication of self-supporting, physiologically relevant networks with intricate and perfusable geometries.

Gelation of Uniform Interfacial Diffusant in Embedded 3D Printing.

While the human body has many different examples of perfusable structures with complex geometries, biofabrication methods to replicate this complexity are still lacking. Specifically, the fabrication of self-supporting, branched networks with multiple channel diameters is particularly challenging. Here, we present the Gelation of Uniform Interfacial Diffusant in Embedded 3D Printing (GUIDE-3DP) approach for constructing perfusable networks of interconnected channels with precise control over branching geometries and vessel sizes. To achieve user-specified channel dimensions, this technique leverages the predictable diffusion of crosslinking reaction-initiators released from sacrificial inks printed within a hydrogel precursor. We demonstrate the versatility of GUIDE-3DP to be adapted for use with diverse physicochemical crosslinking mechanisms by designing seven printable material systems. Importantly, GUIDE-3DP allows for the independent tunability of both the inner and outer diameters of the printed channels and the ability to fabricate seamless junctions at branch points. This 3D bioprinting platform is uniquely suited for fabricating lumenized structures with complex shapes characteristic of multiple hollow vessels throughout the body. As an exemplary application, we demonstrate the fabrication of vasculature-like networks lined with endothelial cells. GUIDE-3DP represents an important advance toward the fabrication of self-supporting, physiologically relevant networks with intricate and perfusable geometries.

Matrix-Assisted In Situ Polymerization of a 3D Conductive Hydrogel Structure.

It is challenging to fabricate 3D architectures of conductive hydrogels and impart uniform conductivity at the same time. Here, we demonstrate a one-step 3D printing technique for controlling the 3D structure of hydrogel materials while simultaneously conferring uniform conductivity. The core technology lies in the in situ polymerization of conductive polymers by the diffusion of monomers and redox initiators to an interface. An alginate ink containing ammonium peroxide as a redox initiator is printed in a silica nanoparticle matrix containing a pyrrole monomer. A 3D structure of conductive polypyrrole is uniformly fabricated on the surface of the alginate immediately after the printing. This simple process provides uniform electrical conductivity throughout the bulk structure.

Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex Improved the Clinical Outcomes in Patients With Persistent Symptomatic Distal Radio-Ulnar Joint Instability After Plate Fixation of Distal Radius Fractures: Minimum 2-Year Follow-Up.

PURPOSE: To investigate the longitudinal trend of symptomatic distal radioulnar joint (DRUJ) instability after plate fixation for distal radius fractures (DRFs), determine which factors are associated with persistent symptomatic DRUJ instability, and evaluate the postoperative outcomes of arthroscopic foveal repair of the triangular fibrocartilage complex (TFCC) in patients with persistent symptomatic DRUJ instability after plate fixation for DRF. METHODS: All consecutive patients who underwent plate fixation for DRF between January 2014 and December 2017 and were followed up for a minimum of 1 year were included in this retrospective study. DRUJ instability was evaluated by subjective ulnar wrist pain and physical examination that included foveal sign and ballottement testing every 2 months after surgery. In patients with persistent symptomatic DRUJ instability lasting >6 months, arthroscopic transosseous foveal repair was performed with consent. Clinical outcomes were evaluated at a minimum of 2 years after surgery. The Generalized Estimating Equation model was used to analyze the incidence rate trend of symptomatic DRUJ instability. RESULTS: Overall, 204 patients were included. The incidence of symptomatic DRUJ instability decreased gradually with time after fixation for DRF until 6 months and was maintained thereafter. Thirty-four of 204 patients (16.6%) had persistent symptomatic DRUJ instability. In multivariable analysis, only high-energy injury was an independent risk factor for persistent symptomatic DRUJ instability (P = .003; odds ratio = 3.599). Seventeen patients underwent arthroscopic foveal repair. The mean follow-up period thereafter was 28.6 months. All clinical outcomes improved significantly compared with preoperative values, and no patient had residual DRUJ instability. CONCLUSION: In patients who had persistent symptomatic DRUJ instability for >6 months after plate fixation for DRFs, arthroscopic foveal repair of the TFCC is considered as a treatment option. Arthroscopic foveal repair of the TFCC to stabilize the DRUJ provided satisfactory clinical and functional outcomes and decreased ulnar-side pain. LEVEL OF EVIDENCE: Level IV, retrospective case series.

3D Printing of Microgel Scaffolds with Tunable Void Fraction to Promote Cell Infiltration.

Granular, microgel-based materials have garnered interest as promising tissue engineering scaffolds due to their inherent porosity, which can promote cell infiltration. Adapting these materials for 3D bioprinting, while maintaining sufficient void space to enable cell migration, can be challenging, since the rheological properties that determine printability are strongly influenced by microgel packing and void fraction. In this work, a strategy is proposed to decouple printability and void fraction by blending UV-crosslinkable gelatin methacryloyl (GelMA) microgels with sacrificial gelatin microgels to form composite inks. It is observed that inks with an apparent viscosity greater than ≈100 Pa s (corresponding to microgel concentrations ≥5 wt%) have rheological properties that enable extrusion-based printing of multilayered structures in air. By altering the ratio of GelMA to sacrificial gelatin microgels, while holding total concentration constant at 6 wt%, a family of GelMA:gelatin microgel inks is created that allows for tuning of void fraction from 0.20 to 0.57. Furthermore, human umbilical vein endothelial cells (HUVEC) seeded onto printed constructs are observed to migrate into granular inks in a void fraction-dependent manner. Thus, the family of microgel inks holds promise for use in 3D printing and tissue engineering applications that rely upon cell infiltration.

Gene Expression of Prox-1 and Hif-1a in Primo Vessels Inside Lymph Vessels of the Rabbit.

The gene expression of Prox-1 and Hif-1a for the isolated primo vessels (PVs) and composite lymphatic vessels (LVs) containing PVs (LVs + PVs) was investigated by RNA-sequencing (Seq) and quantitative polymerase chain reaction (qRT-PCR) analysis. RNA-Seq on the passed 10 samples on RNA-QC for two experimental groups with PVs and PVs + LVs proceeded to the library construction stage automatically and analyzed differentially expressed genes (DEGs). From the real-time qRT-PCR analysis data, we found the marker genes of Prox-1 and Hif-1a were enriched and decreased in an isolated PVs compared to LVs, respectively. Based on mRNA transcriptional data, Prox-1 and Hif-1a were increased and decreased in PVs compared to LVs + PVs under lipopolysaccharide (LPS) treatment and relieved by acupuncture electric stimulation (AES), respectively. This finding indicates that high and low levels of Prox-1 and Hif-1a may be involved in the function of PVs and that pathophysiological and physiological condition could progress into inflamed lymphatic endothelial cells expanding the PV within the LV.

Rheological properties of cellulose nanofiber hydrogel for high-fidelity 3D printing.

Optimization of the rheological properties of the matrix is ​​critical for high-fidelity matrix-assisted 3D printing (MAP), which enables the free-form fabrication of fluidic soft materials. This report describes the generic criteria observable in the printing process of cellulose nanofiber (CNF) hydrogels: the sharpness of an angled line, the cross-sectional ratio of a feature, the surface roughness of features, and the completeness of multi-line writing. The concentration and physical properties of the CNF affects the printing fidelity by changing the values of the four criteria, which are closely related to the rheological properties of the matrix. The printing fidelity can be enhanced by the optimal combination of the inks and the CNF matrix. Hydrophilic and hydrophobic inks are printed in the CNF matrix demonstrating as a universal matrix for free-form fabrication with liquid inks.

Protective coating of strawberries with cellulose nanofibers.

Since shelf life of perishable foods is short, a compelling challenge is to prolong the freshness of foods with a cost-effective strategy. A perishable fruit, the strawberry, is chosen as a model perishable food and an edible film coating is applied to it using carboxymethylated cellulose nanofibers (CM-CNFs) stabilized by cationic salts. A transparent and impermeable CM-CNF film is formed at the strawberry surface using a dip coating process. The formation of the film is dependent on the electrostatic interaction between anionic CM-CNF and salt cations. Physical properties of the film are characterized and the effectiveness of edible film coating on the freshness of perishable fruit is evaluated by the measurement of weight loss, CO2 release, firmness, total solid sugar and acidity. Cellulose nanofiber is a promising cost-effective material appropriate for use as an edible coating that contributes to the long-term storage and prolonged freshness of foods.

3D structure of lightweight, conductive cellulose nanofiber foam.

We investigate the three-dimensional (3D) structuring of cellulose nanofiber (CNF) foam-based ink using direct ink writing 3D printing and the transformation of CNF foam from an insulator to a conductor. The colloidal stability of a CNF foam is critical to producing a solid CNF foam which can be used as a template for the synthesis of conducting polymers. Liquid CNF foam ink is produced by simple stirring of CNF suspension with sodium dodecyl sulfate as an emulsifier. The shear thinning behavior of the liquid CNF foam ink enables printing through a needle. Flexible design of CNF foam structures is enabled by 3D printing using computer-aided design. Lightweight conductive CNF foams are prepared via in situ polymerization of polypyrrole on a solid CNF foam. The topological features of the resultant porous conductive CNF foams are observed, and their conductivity is investigated.

3D Printing of Polyethylene Terephthalate Glycol-Sepiolite Composites with Nanoscale Orientation.

A fused-deposition modeling (FDM) 3D-printed polyethylene terephthalate glycol (PETG)-sepiolite composite showed effective synergetic mechanical reinforcement in tensile testing compared to an injection-molded composite. The results showed that the addition of 3 phr sepiolite improved the tensile strength of 3D-printed PETG samples by 35.4%, while the tensile strength of injection-molded PETG samples was improved by 7.2%. To confirm these phenomena, FDM PETG-sepiolite composites were investigated by small-angle X-ray scattering to correlate the nanostructures of the composites with their mechanical strengths. The small-angle X-ray scattering data and transmission electron microscopy observations demonstrated that needle-shaped sepiolite particles were aligned in the printing direction. This fine oriented nanostructure formed during 3D printing created a synergistic effect that improved the material properties of the composite. These novel PETG-sepiolite composites with enhanced mechanical properties can be promising materials fabricated via FDM 3D printing.

Comparison of the Wide-Awake Approach and Conventional Approach in Extensor Indicis Proprius-to-Extensor Pollicis Longus Tendon Transfer for Chronic Extensor Pollicis Longus Rupture.

BACKGROUND: The wide-awake approach enables surgeons to perform optimal tensioning of a transferred tendon intraoperatively. The authors hypothesized that the extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach would yield better results than conventional surgery. METHODS: A retrospective analysis was performed of the prospectively collected data of 29 consecutive patients who underwent extensor indicis proprius-to-extensor pollicis longus tendon transfer. Patients were treated with the wide-awake approach (group A, n = 11) and conventional surgery under general anesthesia (group B, n = 18). The groups were compared retrospectively for thumb interphalangeal and metacarpophalangeal joint motion, grip and pinch strength, specific extensor indicis proprius-to-extensor pollicis longus evaluation method (SEEM), and Disabilities of the Arm, Shoulder and Hand questionnaire score at 6 weeks and 2, 4, 6, and 12 months postoperatively. RESULTS: Group A showed significantly better interphalangeal joint flexion and total arc of motion at 6 weeks and 2, 4, and 6 months, and significantly better metacarpophalangeal joint flexion and total arc of motion at all time points. Interphalangeal and metacarpophalangeal joint extension showed no difference at all time points. Group A showed significantly better specific extensor indicis proprius-to-extensor pollicis longus evaluation method scores at 2 and 4 months, and Disabilities of the Arm, Shoulder and Hand questionnaire scores at 4, 6, and 12 months. Grip and pinch strength showed no difference at all time points. The complication rate and duration until return to work were not different between groups. CONCLUSION: Compared with the conventional approach, the wide-awake approach showed significantly better results in the thumb's range of motion and functional outcomes, especially in the early postoperative periods. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Biological Activity of Thyme White Essential Oil Stabilized by Cellulose Nanocrystals.

Cellulose nanocrystals (CNCs) are produced by sulfonic acid hydrolysis and used for the formation of Pickering emulsion (PE) with thyme white essential oil (EO). Highly volatile and hydrophobic thyme white is encapsulated in PE by the amphiphilicity of CNCs. Encapsulation of EO in a CNC shell is determined by confocal microscopy with distinct fluorescent labelling. The amount of CNC affects the size distribution of PE, and the emulsion stability is confirmed by rheological property. The antimicrobial activity of the emulsion is evaluated against Escherichia coli and Staphylococcus aureus by minimal inhibitory concentration and minimum bactericidal concentration. The larvicidal activity is also investigated against Aedes albopictus by dispersing the emulsion in water.

Solid matrix-assisted printing for three-dimensional structuring of a viscoelastic medium surface.

Gluconacetobacter xylinus (G. xylinus) metabolism is activated by oxygen, which makes the formation of an air-medium interface critical. Here we report solid matrix-assisted 3D printing (SMAP) of an incubation medium surface and the 3D fabrication of bacterial cellulose (BC) hydrogels by in situ biosynthesis of G. xylinus. A printing matrix of polytetrafluoroethylene (PTFE) microparticles and a hydrogel ink containing an incubation medium, bacteria, and cellulose nanofibers (CNFs) are used in the SMAP process. The hydrogel ink can be printed in the solid matrix with control over the topology and dimensional stability. Furthermore, bioactive bacteria produce BC hydrogels at the surface of the medium due to the permeability of oxygen through the PTFE microparticle layer. The flexibility of the design is verified by fabricating complex 3D structures that were not reported previously. The resulting tubular BC structures suggest future biomedical applications, such as artificial blood vessels and engineered vascular tissue scaffolding. The fabrication of a versatile free-form structure of BC has been challenged due to restricted oxygen supplies at the medium and the dimensional instability of hydrogel printing. SMAP is a solution to the problem of fabricating free-form biopolymer structures, providing both printability and design diversity.

Transparent cellulose nanofiber based open cell culture platform using matrix-assisted 3D printing.

Carboxymethylated hydrophilic CNF (Hphil-CNF) was modified with methyltrimethoxysilane into hydrophobic CNF (Hphob-CNF) and used as a printing matrix. The Hphil-CNF hydrogel was printed at the surface of the Hphob-CNF hydrogel, forming an immiscible, distinct 3D structure. Fabrication of channel systems in the CNF platform was performed by matrix-assisted 3D printing of petroleum jelly ink in the Hphil-CNF-patterned Hphob-CNF hydrogel. After the dehydration process followed by removal of the ink from the CNF film, the CNF hydrogels became a dense platform embedding fluidic channels. The CNF platform exhibited selective diffusion of fluorescein isothiocyanate-dextran from the channels in the Hphil-CNF patterns, indicating transport of bioactive molecules to cells cultured at the platform surface. The applicability of the open cell culture platform was investigated with A549 lung cancer cells by injecting cisplatin, a model drug into the channel.

pH-Triggered Silk Fibroin/Alginate Structures Fabricated in Aqueous Two-Phase System.

An aqueous two-phase system (ATPS) is a water-in-water biphasic system, which is generally formed by two incompatible polymers. Recently, considerable effort has been dedicated to search for new ATPS polymer pairs to further expand ATPS's applications. In this paper, a new ATPS system based on silk fibroin (SF) and alginate is introduced. A phase diagram was established to show the critical concentrations for the formation of an SF/alginate ATPS. The present system is sensitive to pH stimulus and transformed from an ATPS into a single-phasic system as pH increases above ∼9.5. Circular dichroism, fluorescence emission spectra, hydrodynamic diameter, and ζ-potential data together indicate that the SF chains undergo a dramatic extension as pH is increased, which is the reason underlying the pH-triggered phase transition. As feasible applications of this biphasic system, compartmentalized multiplex immunoassay, controlled encapsulation and release, and hierarchical fiber fabrication were demonstrated using the SF/alginate ATPS.

Melanin Nanoparticle-Incorporated Silk Fibroin Hydrogels for the Enhancement of Printing Resolution in 3D-Projection Stereolithography of Poly(ethylene glycol)-Tetraacrylate Bio-ink.

It is not easy to design structures with transparent solutions, especially in light projection three-dimensional (3D) printing, since the penetration of light in solution is limitless. Here, silk fibroin incorporated with melanin nanoparticles (SFM) is used as a transparency modifier of poly(ethylene glycol)-tetraacrylate (PEG4A) solution. The incorporation of melanin into the SF hydrogel is performed in the range of 0.05-0.2% (w/v), and the SFM was added to the PEG4A precursor solution at 0.25-1.0% (w/v). The printing accuracy was examined by comparing the printed and designed feature sizes. The addition of 1.0% (w/v) SFM to a 4% (w/v) PEG4A (PEG4A/SFM) precursor solution effectively reduces the transparency of the solution and improves the printing resolution by confining the light beam to a designed region. This enables the fabrication of hard-to-express features such as hollow blood vessels or vacant tubes. Furthermore, the elastic modulus of the printed PEG4A/SFM composite hydrogel increases 2.5-fold higher than the PEG4A hydrogel without SFM. For the bio-ink, PEG4A/SFM-containing cells show non-cytotoxicity and improve the proliferation rate of embedded cells, confirming the high biocompatibility of PEG4A/SFM hydrogels.

Matrix-Assisted Three-Dimensional Printing of Cellulose Nanofibers for Paper Microfluidics.

A cellulose nanofiber (CNF), one of the most attractive green bioresources, was adopted for construction of microfluidic devices using matrix-assisted three-dimensional (3D) printing. CNF hydrogels can support structures printed using CAD design in a 3D hydrogel environment with the appropriate combination of rheological properties between the CNF hydrogel and ink materials. Amazingly, the structure printed freely in the bulky CNF hydrogels was able to retain its highly resolved 3D features in an ultrathin two-dimensional (2D) paper using a simple drying process. The dimensional change in the CNF hydrogels from 3D to 2D resulted from simple dehydration of the CNFs and provided transparent, stackable paper-based 3D channel devices. As a proof of principle, the rheological properties of the CNF hydrogels, the 3D structure of the ink, the formation of channels by evacuation of the ink, and the highly localized selectivity of the devices are described.

Nanocellulose based asymmetric composite membrane for the multiple functions in cell encapsulation.

We describe the nanocomposite membrane for cell encapsulation using nanocelluose hydrogels. One of the surfaces of bacterial cellulose (BC) pellicles was coated with collagen to enhance cell adhesion and the opposite side of the BC pellicles was coated with alginate to protect transplanted cells from immune rejection by the reduced pore size of the composite membrane. The morphology of nanocomposite membrane was observed by scanning electron microscopy and the permeability of the membrane was estimated by the release test using different molecular weights of polymer solution. The nanocomposite membrane was permeable to small molecules but impermeable to large molecules such as IgG antibodies inferring the potential use in cell implantation. In addition, the BC-based nanocomposite membrane showed a superior mechanical property due to the incorporation of compared with alginate membranes. The cells attached efficiently to the surface of BC composite membranes with a high level of cell viability as well as bioactivity. Cells grown on the BC composite membrane kit released dopamine freely to the medium through the membrane, which showed that the BC composite membrane would be a promising cell encapsulation material in implantation.