Weibull parametric model for survival analysis in women with endometrial cancer using clinical and T2-weighted MRI radiomic features.

BACKGROUND: Semiparametric survival analysis such as the Cox proportional hazards (CPH) regression model is commonly employed in endometrial cancer (EC) study. Although this method does not need to know the baseline hazard function, it cannot estimate event time ratio (ETR) which measures relative increase or decrease in survival time. To estimate ETR, the Weibull parametric model needs to be applied. The objective of this study is to develop and evaluate the Weibull parametric model for EC patients' survival analysis. METHODS: Training (n = 411) and testing (n = 80) datasets from EC patients were retrospectively collected to investigate this problem. To determine the optimal CPH model from the training dataset, a bi-level model selection with minimax concave penalty was applied to select clinical and radiomic features which were obtained from T2-weighted MRI images. After the CPH model was built, model diagnostic was carried out to evaluate the proportional hazard assumption with Schoenfeld test. Survival data were fitted into a Weibull model and hazard ratio (HR) and ETR were calculated from the model. Brier score and time-dependent area under the receiver operating characteristic curve (AUC) were compared between CPH and Weibull models. Goodness of the fit was measured with Kolmogorov-Smirnov (KS) statistic. RESULTS: Although the proportional hazard assumption holds for fitting EC survival data, the linearity of the model assumption is suspicious as there are trends in the age and cancer grade predictors. The result also showed that there was a significant relation between the EC survival data and the Weibull distribution. Finally, it showed that Weibull model has a larger AUC value than CPH model in general, and it also has smaller Brier score value for EC survival prediction using both training and testing datasets, suggesting that it is more accurate to use the Weibull model for EC survival analysis. CONCLUSIONS: The Weibull parametric model for EC survival analysis allows simultaneous characterization of the treatment effect in terms of the hazard ratio and the event time ratio (ETR), which is likely to be better understood. This method can be extended to study progression free survival and disease specific survival. TRIAL REGISTRATION: ClinicalTrials.gov NCT03543215, https://clinicaltrials.gov/ , date of registration: 30th June 2017.

The Hammersmith Score optimises patient selection and predicts for overall survival in early-phase cancer trial participants independent of tumour burden.

INTRODUCTION: As tumour response rates are increasingly demonstrated in early-phase cancer trials (EPCT), optimal patient selection and accurate prognostication is paramount. Hammersmith Score (HS), a simple prognostic index derived on routine biochemical measures (Albumin <35g/L, Lactate Dehydrogenase (LDH) >450 IU/L, Sodium <135mmol/L) is a validated predictor of response and survival in EPCT participants. HS has not been validated in the cancer immunotherapy era. METHODS: We retrospectively analysed characteristics and outcomes of unselected referrals to our early-phase unit (12/2019-12/2022). Independent predictors for overall survival (OS) were identified from univariable and multivariable models. HS was calculated for 66 eligible trial participants and compared with the Royal Marsden Score (RMS) to predict OS. Multivariable logistic regression and c-index was used to compare predictive ability of prognostic models. RESULTS: Of 212 referrals, 147 patients were screened and 82 patients treated in EPCT. Prognostic stratification by HS identifies significant difference in median OS and HS was confirmed as a multivariable predictor for OS (HR: HS 1 vs. 0 2.51, 95%CI: 1.01-6.24, p=0.049; HS 2/3 vs. 0: 10.32, 95%CI: 2.15-49.62, p=0.004; C-index 0.771) with superior multivariable predictive ability than RMS (HR: RMS 2 vs. 0/1 5.46, 95%CI: 1.12-26.57, p=0.036; RMS 3 vs. 0/1 6.83, 95%CI: 1.15-40.53, p<0.001; C-index 0.743). CONCLUSIONS: HS is a validated prognostic index for patients with advanced cancer treated in the context of modern EPCTs, independent of tumour burden. HS is a simple, inexpensive prognostic tool to optimise referral for EPCT.

Hyaluronic acid/polyphenol sunscreens with broad-spectrum UV protection properties from tannic acid and quercetin.

Currently, commercial sunscreens cause a number of biotoxicity and environmental issues, making it imperative to develop biocompatible alternatives. In this study, we aimed to develop an alternative sunscreen from two ecofriendly and biocompatible natural polyphenolic compounds, tannic acid (TA) and quercetin (Que). The sunscreen was prepared through a simple process using an oil-in-water emulsion as the medium and hyaluronic acid (HA) as the base polymer to improve biocompatibility. The HA/TA/Que. sunscreen prepared in this study exhibits 0 % transmittance in the UVB region and <15 % transmittance in the UVA region, resulting in excellent sun-protection properties (SPF 30). Remarkably, the as-prepared HA/TA/Que. sunscreen has a suitable viscosity and similar UV protection properties to those of commercial sunscreens. The HA/TA/Que. sunscreen also exhibits 90.4 % antioxidant activity against 2,2-diphenyl-1-picrylhydrazyl, demonstrating an ability to effectively capture reactive oxygen species that directly affect the skin. In addition, the cell viability was >90 % at a concentration of 50 µg/mL after 7 days, indicating excellent cytocompatibility. Owing to its various advantageous features, the HA/TA/Que. sunscreen with excellent sun protection properties and multiple functionalities is expected to resolve many environmental and biological issues caused by commercial sunscreens.

An Atelocollagen Injection Enhances the Healing of Nonoperatively Treated Achilles Tendon Tears: An Experimental Study in Rats.

Background: There is growing interest in nonoperative treatment for the management of Achilles tendon ruptures (ATRs). However, nonoperative treatment is limited by the risk of tendon reruptures and low satisfaction rates. Recently, atelocollagen injections have been reported to have beneficial effects on tendon healing. Purpose: To evaluate the beneficial effects of injected atelocollagen on Achilles tendon healing and investigate the mechanism of atelocollagen on tendon healing. Study Design: Controlled laboratory study. Methods: Percutaneous tenotomy of the right Achilles tendon in 66 rats was performed. The animals were equally divided into the noninjection group (NG) and the collagen injection group (CG). At 1, 3, and 6 weeks, the Achilles functional index, cross-sectional area, load to failure, stiffness, stress, and the modified Bonar score were assessed. Transmission electron microscopy, western blotting, and immunohistochemistry were also performed. Results: The Achilles functional index (-6.8 vs -43.0, respectively; P = .040), load to failure (42.1 vs 27.0 N, respectively; P = .049), and stiffness (18.8 vs 10.3 N/mm, respectively; P = .049) were higher in the CG than those in the NG at 3 weeks. There were no significant differences in histological scores between the 2 groups. Transmission electron microscopy analysis showed that the mean diameter of collagen fibrils in the CG was greater than that in the NG at 3 weeks (117.2 vs 72.6 nm, respectively; P < .001) and 6 weeks (202.1 vs 144.0 nm, respectively; P < .001). Western blot analysis showed that the expression of collagen type I in the CG was higher than that in the NG at 1 week (P = .005) and 6 weeks (P = .001). Conclusion: An atelocollagen injection had beneficial effects on the healing of nonoperatively treated Achilles tendon injuries. The Achilles tendon of CG rats exhibited better functional, biomechanical, and morphological outcomes compared with NG rats. The molecular data indicated that the mechanism of atelocollagen injections may be associated with an increased amount of collagen type I. Clinical Relevance: An atelocollagen injection might be a good adjuvant option for the nonoperative treatment of ATRs.

Prediction of Deep Myometrial Infiltration, Clinical Risk Category, Histological Type, and Lymphovascular Space Invasion in Women with Endometrial Cancer Based on Clinical and T2-Weighted MRI Radiomic Features.

PURPOSE: To predict deep myometrial infiltration (DMI), clinical risk category, histological type, and lymphovascular space invasion (LVSI) in women with endometrial cancer using machine learning classification methods based on clinical and image signatures from T2-weighted MR images. METHODS: A training dataset containing 413 patients and an independent testing dataset consisting of 82 cases were employed in this retrospective study. Manual segmentation of the whole tumor volume on sagittal T2-weighted MRI was performed. Clinical and radiomic features were extracted to predict: (i) DMI of endometrial cancer patients, (ii) endometrial cancer clinical high-risk level, (iii) histological subtype of tumor, and (iv) presence of LVSI. A classification model with different automatically selected hyperparameter values was created. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, F1 score, average recall, and average precision were calculated to evaluate different models. RESULTS: Based on the independent external testing dataset, the AUCs for DMI, high-risk endometrial cancer, endometrial histological type, and LVSI classification were 0.79, 0.82, 0.91, and 0.85, respectively. The corresponding 95% confidence intervals (CI) of the AUCs were [0.69, 0.89], [0.75, 0.91], [0.83, 0.97], and [0.77, 0.93], respectively. CONCLUSION: It is possible to classify endometrial cancer DMI, risk, histology type, and LVSI using different machine learning methods.

pH-sensitive gallol-rich chitosan hydrogel beads for on-off controlled drug delivery.

Malignant tumors have emerged as a serious health issue, and the interest in developing pH-sensitive polymers for site-specific drug delivery has increased. The physical and/or chemical properties of pH-sensitive polymers depend on the pH, and thus, drugs can be released by cleaving dynamic covalent and/or noncovalent bonds. In this study, gallic acid (GA) was conjugated to chitosan (CS) to prepare self-crosslinked hydrogel beads containing Schiff base (imine bond) crosslinks. The CS-GA hydrogel beads were formed by the dropwise addition of the CS-GA conjugate solution into a Tris-HCl buffer solution (TBS, pH 8.5). The pH-sensitivity of pristine CS was significantly enhanced following the introduction of GA moiety, and as a result, the CS-GA hydrogel beads swelled more than approximately 5000 % at pH 4.0, indicating an excellent swelling/deswelling ability of the beads at different pH (pH 4.0 and 8.5). The reversible breakage/recovery of the imine crosslinks in the CS-GA hydrogel beads was confirmed through X-ray photoelectron spectroscopic and rheological studies. Finally, Rhodamine B was loaded onto the hydrogel beads as a model drug to investigate the pH-sensitive drug release behavior. At pH 4, the drug was released up to approximately 83 % within 12 h. The findings indicate that the CS-GA hydrogel beads have great potential as a drug delivery system that is sensitive to acidic tumor sites in the body.

Tannic-Acid-Enriched Poly(vinyl alcohol) Nanofibrous Membrane as a UV-Shie lding and Antibacterial Face Mask Filter Material.

Face masks are increasingly important in the battle against infectious diseases and air pollution. Nanofibrous membranes (NFMs) are promising filter layers for removing particulate matter (PM) without restricting air permeability. In this study, tannic-acid-enriched poly(vinyl alcohol) (PVA-TA) NFMs were fabricated by electrospinning PVA solutions containing large amounts of tannic acid (TA), a multifunctional polyphenol compound. We were able to prepare uniform electrospinning solution without coacervate formation by inhibiting the robust hydrogen bonding between PVA and TA. Notably, the NFM maintained its fibrous structure even under moist conditions after heat treatment without the use of a cross-linking agent. Further, the mechanical strength and thermal stability of the PVA NFM were improved by the introduction of TA. The functional PVA NFM with a high TA content showed excellent UV-shielding (UV-A: 95.7%, UV-B: 100%) and antibacterial activity against Escherichia coli (inhibition zone: 8.7 ± 1.2 mm) and Staphylococcus aureus (inhibition zone: 13.7 ± 0.6 mm). Moreover, the particle filtration efficiency of the PVA-TA NFM for PM0.6 particles was 97.7% at 32 L min-1 and 99.5% at 85 L min-1, indicating excellent filtration performance and a low pressure drop. Therefore, the TA-enriched PVA NFM is a promising mask filter layer material with excellent UV-blocking and antibacterial properties and has the potential for various practical applications.

Personalized Prehabilitation Improves Tolerance to Chemotherapy in Patients with Oesophageal Cancer.

BACKGROUND: Prehabilitation programmes aim to optimise patients before and after cancer treatment including surgery. Previous studies in surgical patients demonstrate that prehabilitation improves pre-operative fitness and overcomes the negative impact of neoadjuvant chemotherapy on fitness. The aim of this study was to assess the impact of prehabilitation on the tolerance of neoadjuvant chemotherapy in patients with oesophageal cancer. METHODS: Patients with oesophageal or gastroesophageal junction (GOJ) cancer from two oncology centres were retrospectively included in the present comparative cohort study; one provided a multimodal prehabilitation programme and one did not offer any prehabilitation. Tolerance of chemotherapy, defined as completion of the full chemotherapy regime as per protocol, was compared between the two groups. RESULTS: In terms of participants, 92 patients were included in this study, 47 patients in the prehabilitation cohort and 45 in the control cohort. Compared with the control group, the prehabilitation group demonstrated an improved rate of chemotherapy completion (p = 0.029). In multivariate analysis, participation in prehabilitation was significantly associated with an improved rate of chemotherapy completion. CONCLUSION: The findings of this exploratory study suggest that prehabilitation is associated with better tolerance for chemotherapy. Further research is needed to establish the long-term impact of prehabilitation on oncological outcomes.

Highly gallol-substituted, rapidly self-crosslinkable, and robust chitosan hydrogel for 3D bioprinting.

Although three-dimensional (3D) bioprinting is a promising technology for reconstructing artificial tissues and organs using bioink, there is a lack of a bioink that satisfies all requirements, including printability, gelation, mechanical properties, and cytocompatibility, Herein, a novel self-crosslinkable bioink derived from chitosan (CS) and gallic acid (GA) is presented. 3D printed scaffolds with excellent shape fidelity are realized by systematically analyzing the self-crosslinking mechanism of hydrogel formation from CS-GA conjugates and by optimizing various parameters of the printing process. The CS-GA hydrogel forms rapidly in a physiological pH without any chemical crosslinking agent. In addition, the CS-GA hydrogel exhibited various physical and chemical intermolecular interactions, fast gelation rates, and excellent mechanical properties (>337 kPa). Moreover, the CS-GA hydrogel singificantly improves the cell viability (>92 %) and proliferation of the bioink. Therefore, the self-crosslinkable CS-GA bioink has great potential to overcome the limitations of conventional bioinks.

Eco-friendly silk fibroin/tannic acid coacervates for humid and underwater wood adhesives.

Bioadhesives derived from biomass are steadily gaining spotlight as substitutes for formaldehyde-based resins in the adhesive industry. However, there is a need to develop novel water-resistant bioadhesives with high adhesive and cohesive strengths because the currently available biomaterial-based adhesives have low mechanical strength. In this study, a complex coacervate was prepared easily by mixing silk fibroin and tannic acid to produce a bioadhesive with high adhesive and cohesive strengths as well as water resistance. The silk fibroin-tannic acid coacervate adhered well to various substrates, and its adhesive strength according to the type of substrate and water contact angle were evaluated comparatively. In particular, the adhesive strength of this adhesive on a wood substrate was systematically analyzed by varying different experimental parameters (relative humidity, surface roughness of the substrate, water stability, and pH). This cost-effective coacervate is applicable as an eco-friendly wood adhesive.

Ecofriendly poly(3-hydroxybutyrate-co-4-hydroxybutyrate) microbeads for sanitary products.

In the past, plastic microbeads (MBs) were added to personal healthcare products to improve the cleaning and exfoliating effects, but these have been withdrawn owing to their non-degradable nature and contribution to the pollution of marine environment, especially that caused by the adsorption of persistent organic pollutants (POPs) on MBs. Therefore, natural biodegradable alternatives are being developed, but these often do not exhibit sufficient performance to replace non-degradable MBs. In this study, poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (P3HB-4HB), a biodegradable aliphatic polyester, was used to prepare MBs via melt-electrospraying. We carried out the rheological characterization of P3HB-4HB with respect to melting temperature, and the melt-electrospray process was optimized to prepare MBs having sizes similar to those of commercially available MBs. Furthermore, the adsorption properties of the P3HB-4HB MBs for POPs were investigated. Unlike commercial MBs, the P3HB-4HB MBs adsorbed significantly fewer contaminants owing to their smooth and regular surfaces. Finally, a cleansing product containing P3HB-4HB MBs was prepared to evaluate their cleaning ability, and we found that the MB-based product could remove dirt and contaminants that were not easily removed by water alone. Thus, the biodegradable P3HB-4HB MBs have great potential for use as sustainable additives for cosmetic products for skin exfoliation.

An Integrated Clinical-MR Radiomics Model to Estimate Survival Time in Patients With Endometrial Cancer.

BACKGROUND: Determination of survival time in women with endometrial cancer using clinical features remains imprecise. Features from MRI may improve the survival estimation allowing improved treatment planning. PURPOSE: To identify clinical features and imaging signatures on T2-weighted MRI that can be used in an integrated model to estimate survival time for endometrial cancer subjects. STUDY TYPE: Retrospective. POPULATION: Four hundred thirteen patients with endometrial cancer as training (N = 330, 66.41 ± 11.42 years) and validation (N = 83, 67.60 ± 11.89 years) data and an independent set of 82 subjects as testing data (63.26 ± 12.38 years). FIELD STRENGTH/SEQUENCE: 1.5-T and 3-T scanners with sagittal T2-weighted spin echo sequence. ASSESSMENT: Tumor regions were manually segmented on T2-weighted images. Features were extracted from segmented masks, and clinical variables including age, cancer histologic grade and risk score were included in a Cox proportional hazards (CPH) model. A group least absolute shrinkage and selection operator method was implemented to determine the model from the training and validation datasets. STATISTICAL TESTS: A likelihood-ratio test and decision curve analysis were applied to compare the models. Concordance index (CI) and area under the receiver operating characteristic curves (AUCs) were calculated to assess the model. RESULTS: Three radiomic features (two image intensity and volume features) and two clinical variables (age and cancer grade) were selected as predictors in the integrated model. The CI was 0.797 for the clinical model (includes clinical variables only) and 0.818 for the integrated model using training and validation datasets, the associated mean AUC value was 0.805 and 0.853. Using the testing dataset, the CI was 0.792 and 0.882, significantly different and the mean AUC was 0.624 and 0.727 for the clinical model and integrated model, respectively. DATA CONCLUSION: The proposed CPH model with radiomic signatures may serve as a tool to improve estimated survival time in women with endometrial cancer. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

Poly(vinyl alcohol) nanofibrous membranes via green electrospinning and tannin coating for selective removal of Pb(II) ion.

The conventional adsorbent fabrication methods involve complicated processes and may cause secondary contaminations. Therefore, an effective eco-friendly method is required for the fabrication of heavy metal adsorbents using inexpensive and eco-friendly materials without secondary pollution during their process. In this study, nanofibrous membranes (NFMs) were fabricated via green electrospinning of poly(vinyl alcohol) (PVA), a hydrophilic polymer, and their water resistance was improved through simple heat treatment without using additional additives. Then, nanofibrous heavy metal adsorbents were prepared by dip-coating the NFMs in an aqueous solution of tannic acid (TA), a natural polyphenol. First, the adsorption/desorption behavior of TA on PVA NFMs during the TA coating process was investigated. In addition, the effects of TA coating on the mechanical properties and heavy metal adsorption characteristics of the PVA NFMs were analyzed. The TA coating significantly increased the mechanical strength, heat resistance, and heavy metal (Pb(II)) adsorption capacity of the PVA NFM. The Pb2+ adsorption amount of TA-coated PVA NFMs exhibited about 5-7 times higher than those of other heavy metal ions, indicating excellent selectivity for Pb2+. In addition, the TA-coated PVA NFMs retained >70% of its initial adsorption capacity even after four cycles of adsorption/desorption, indicating its reusability.

ZnO nanoparticle-embedded modified silk fibroin-tannin multifunctional hydrogel.

Owing to the destruction of ozone layer, the increased exposure to UV on the earth adversely affects not only skin diseases but also wound healing. Although the demand for sunscreens is increasing to protect the human skin from these adverse effects, commercially available sunscreens have some limitations in safety. In this study, silk fibroin (SF) composite with biocompatibility and blood coagulation activity was prepared for a highly safe sunscreen. However, the SF has a disadvantage in that it is difficult to dissolve in water. To improve the solubility of SF, butyl glycidyl ether (BGE) was reacted with the side chain of SF to prepare a freely water-soluble SF (mSF) derivative, and the phase behavior according to the mixing ratio of SF derivative and tannic acid (TA) was observed. In addition, ZnO nanoparticles were added to the mSF-TA solution to form a hydrogel through the coordination bonding. The UV blocking, hemostatic, antibacterial and antioxidant effects of the mSF/TA/ZnO composite hydrogel were evaluated, and the excellent skin compatibility of multifunctional hydrogel sunscreen was confirmed through a skin irritation test.

Multifunctional and thermoresponsive methylcellulose composite hydrogels with photothermal effect.

Multifunctional and thermoresponsive hydrogels can be used as soft materials in various medical applications, such as beauty devices, drug delivery, and near-infrared (NIR) lasers. In this study, methylcellulose (MC) composite hydrogels containing tannic acid (TA) and Fe3+ were prepared via a simple, fast process. The MC composite hydrogel contains hydrogen bonds between the MC polymer and TA and coordination bonds between TA and Fe3+, without losing the reversible thermogelation properties of the MC polymer. The gelation rates and mechanical properties of the MC composite hydrogel were controlled by varying its TA and Fe3+ contents. In particular, the hydrogel with a TA-Fe chelating complex showed an excellent photothermal effect, indicating its potential application in cosmetic beauty devices. It also exhibited UV-blocking, antioxidant, and antibacterial properties owing to the multifunctional TA. The facile processing of these MC/TA/Fe hydrogels provides new opportunities for biomedical applications and beauty devices employing NIR laser therapy.

Stretchable and Self-Healable Poly(styrene-co-acrylonitrile) Elastomer with Metal-Ligand Coordination Complexes.

Recently, soft electronics have attracted significant attention for various applications such as flexible devices, artificial electronic skins, and wearable devices. For practical applications, the key requirements are an appropriate electrical conductivity and excellent elastic properties. Herein, using the cyano-silver complexes resulting from coordination bonds between the nitrile group of poly(styrene-co-acrylonitrile) (SAN) and Ag ions, a self-healing elastomer demonstrating electrical conductivity is obtained. Because of these coordination complexes, the Ag-SAN elastomer possesses elasticity, compared with pristine SAN. The fracture strain of the Ag-SAN elastomers increased with the amount of added Ag ions, reaching up to 1000%. Additionally, owing to the presence of reversible coordination bonds, the elastomer exhibits self-healing properties at room temperature and electrical conductivity, thereby improving the possibility of its utilization in novel applications wherein elastic materials are generally exposed to external stimuli.

Hyaluronic acid/tannic acid hydrogel sunscreen with excellent anti-UV, antioxidant, and cooling effects.

Excessive exposure to UV radiation is one of the major factors that causes skin aging, erythema, burns, and skin cancer. Recently, the usage of sunscreens for skin protection has increased because the amount of UV radiation reaching the Earth's surface has increased owing to the destruction of the ozone layer that blocks UV radiation. Hydrogels with a three-dimensional network structure exhibit physical and chemical properties that are similar to those of the extracellular matrix in the human body, a high water content, flexibility, and biocompatibility. Therefore, they are applied in a wide range of fields, such as in cosmetics, medicines, and pharmaceuticals. However, conventional hydrogel-based sunscreens have drawbacks such as complicated process conditions, high cost, and low biocompatibility. In this study, a novel hydrogel-type sunscreen with excellent UV protection and cooling effects was prepared by a very simple process using two natural materials, hyaluronic acid (HA) and tannic acid (TA). The HA/TA hydrogels exhibited broad-spectrum UV protection in the UVA and UVB regions (280-360 nm). In addition, they showed excellent adhesion to the skin surface, antioxidative activity, cooling effect, and high moisture content, demonstrating great application potential as a hydrogel-type sunscreen.

Effect of tannic acid on the mechanical and adhesive properties of catechol-modified hyaluronic acid hydrogels.

Hyaluronic acid (HA) is applied in various fields, including pharmaceutical science, owing to its favorable biological properties such as moisture retention, non-toxicity, biodegradability, biocompatibility and biodegradability. In particular, many studies have aimed at its application in the form of a hydrogel. However, the applications of HA hydrogels are limited owing to their poor mechanical properties. In this study, an HA-catechol conjugate (HA-Cat) was synthesized by reacting the HA polymer with dopamine to improve its adhesion to various substrates. The HA-Cat hydrogel was prepared via oxidative crosslinking using a small amount of NaIO4 as the oxidant, and the hydrogel formation was investigated by rheological and mechanical studies. Further, the effect of tannic acid (TA) on the adhesive strength and compressive strength of the HA-Cat/TA hydrogels was examined according to the amount of NaIO4 used for crosslinking and the TA contents. Both the adhesive and compressive properties of the HA-Cat hydrogels were improved with the addition of TA. The HA-based hydrogels containing TA have great potential as cost-effective and biocompatible medical adhesives.

Extended Distal Chevron Osteotomy and Akin Osteotomy Using Bioabsorbable Materials for Treatment of Moderate to Severe Hallux Valgus.

The purpose of this study was to investigate the suitability of bioabsorbable materials for fixation of extended distal chevron osteotomy and Akin osteotomy for the treatment of moderate to severe hallux valgus. We performed a retrospective analysis of extended distal chevron osteotomy and Akin osteotomy for the treatment of moderate to severe hallux valgus (33 patients, 42 feet). Fixation of extended distal chevron osteotomy and Akin osteotomy was performed using poly-l-lactic acid pins and polylactic acid/polyglycolic acid copolymer sutures, respectively. The radiological outcomes were evaluated based on the preoperative and 3-year follow-up intermetatarsal angle, hallux valgus angle, and hallux interphalangeal angle. The clinical results were assessed according to 3-year follow-up Manchester-Oxford Foot Questionnaire scores, patient satisfaction, and postoperative complications. All radiological and clinical results were compared with those of a control group treated with metallic implants. The mean 3-year follow-up intermetatarsal angle, hallux valgus angle, and hallux interphalangeal angle were significantly corrected from the preoperative values (all p < .001). The mean 3-year follow-up Manchester-Oxford Foot Questionnaire scores score was significantly improved from the preoperative values (p < .001). Regarding patient satisfaction, 88.1% of the patients reported good to excellent results. A total of seven complications were reported. All radiological and clinical results were comparable with those of control group treated with metallic implant. Based on these results, we recommend using bioabsorbable materials as another reliable device for fixation of extended distal chevron osteotomy and Akin osteotomy even for the treatment of moderate to severe hallux valgus.

Self-crosslinkable hyaluronate-based hydrogels as a soft tissue filler.

With increasing interest in aging and skin care, the use of fillers to increase the volume of soft tissue volume is increasing globally. However, the side effects caused by the residual chemical crosslinking agents present in these fillers limit the effective application of commercialized filler products. Therefore, the development of a novel crosslinking system with a non-toxic chemical crosslinking agent is required to overcome the limitations of commercial hyaluronate (HA)-based fillers. In this paper, a new injectable hydrogel with enhanced mechanical properties, tissue adhesion, injectability, and biocompatibility is reported. The HA derivatives modified with catechol groups (HA-DA) were crosslinked by self-oxidation under in vivo physiological conditions (pH 7.4) without chemical crosslinkers to form hydrogels, which can be further accelerated by the dissolved oxygen in the body. The fabricated HA-DA filler showed excellent mechanical properties and could be easily injected with a low injection force. Further, the HA-DA filler stably attached to the injection site due to the tissue adhesion properties of the catechol groups, thus leading to an improved displacement stability. In addition, the HA-DA filler showed excellent cell viability, cell proliferation, and biocompatibility. Therefore, the HA-DA hydrogel is a novel soft tissue filler with great potential to overcome the limitations of commercial soft tissue fillers.