The experience of anxiety among Chinese undergraduate nursing students in the later period of their internships: findings from a qualitative study.

BACKGROUND: Clinical internships are a critical transition period for nursing students to develop into nursing professionals and are essential for the solidification of their professional attitudes. Undergraduate nursing students face multiple sources of severe anxiety that affect their nursing career development during this period. This study aimed to understand the anxiety experienced by undergraduate nursing students in the later period of their internship periods in a Chinese educational context. METHODS: A descriptive qualitative study was conducted. A purposive sample of 17 undergraduate nursing interns with experiences of anxiety was selected from three teaching hospitals in Hunan Province, China. Data were collected through semi-structured interviews and analyzed using the Colaizzi seven-step method for data analysis. RESULTS: Three themes emerged: the sources of perceived anxiety, the psychological journey of coping with anxiety, and suggestions for nursing management and education. The sub-themes for the first theme included career decision dilemmas, competitive pressures for employment, worries about progress of the graduation projects, challenges of the nursing licensure examination, and low self-confidence in clinical competence. The second theme consisted of two sub-themes: negative avoidance and retreat, and positive preparation and response. The third theme consisted of policy support to create more employment opportunities, comprehensive guidance from nursing schools and hospitals, and psychological assistance and counseling. CONCLUSIONS: This study revealed that undergraduate nursing students were prone to anxiety during the later period of their clinical internships. Specific sources of anxiety encompassed career decision-making, job pursuit, graduation, and licensure examination. Undergraduate nursing students adopted both positive and negative approaches in coping with anxiety during the later period of their clinical internships. Nursing educators and administrators should develop appropriate instructions and support systems to reduce anxiety among undergraduate nursing students.

Self-Efficacy Intervention Programs in Patients with Chronic Obstructive Pulmonary Disease: Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a common chronic disease whose development is irreversible, which leads to more than six million deaths each year. There is no treatment confirmed effective for the improvement of impaired lung function, but the combination of drug therapy with non-drug therapy such as pulmonary rehabilitation training has demonstrated a great potential in reducing the occurrence of complications and delaying the progression of COPD. Self-efficacy is the core of cognitive theory, which is crucial for chronic disease management. It has been proposed as an important component of disease management to help people develop skills to manage diseases more effectively. This study reviewed the development of self-efficacy and its application in patients with COPD, with the purpose of providing a better clinical reference for the treatments of COPD.

Bedaquiline-containing regimens in patients with pulmonary multidrug-resistant tuberculosis in China: focus on the safety.

BACKGROUND: World Health Organization recommends countries introducing new drug and short treatment regimen for drug resistant tuberculosis (DR-TB) should develop and implement a system for active pharmacovigilance that allows for detection, reporting and management of adverse events. The aim of the study is to evaluate the frequency and severity of adverse events (AEs) of bedaquiline-containing regimen in a cohort of Chinese patients with multidrug-resistant (MDR)/extensively drug-resistant (XDR)-TB based on active drug safety monitoring (aDSM) system of New Drug Introduction and Protection Program (NDIP). METHODS: AEs were prospectively collected with demographic, bacteriological, radiological and clinical data from 54 sites throughout China at patient enrollment and during treatment between February, 2018 and December, 2019. This is an interim analysis including patients who are still on treatment and those that have completed treatment. A descriptive analysis was performed on the patients evaluated in the cohort. RESULTS: By December 31, 2019, a total of 1162 patients received bedaquiline-containing anti-TB treatment. Overall, 1563 AEs were reported, 66.9% were classified as minor (Grade 1-2) and 33.1% as serious (Grade 3-5). The median duration of bedaquiline treatment was 167.0 [interquartile range (IQR): 75-169] days. 86 (7.4%) patients received 36-week prolonged treatment with bedaquiline. The incidence of AEs and serious AEs was 47.1% and 7.8%, respectively. The most frequently reported AEs were QT prolongation (24.7%) and hepatotoxicity (16.4%). There were 14 (1.2%) AEs leading to death. Out of patients with available corrected QT interval by Fridericia's formula (QTcF) data, 3.1% (32/1044) experienced a post-baseline QTcF ≥ 500 ms, and 15.7% (132/839) had at least one change of QTcF ≥ 60 ms from baseline. 49 (4.2%) patients had QT prolonged AEs leading to bedaquiline withdrawal. One hundred and ninety patients reported 361 AEs with hepatotoxicity ranking the second with high occurrence. Thirty-four patients reported 43 AEs of hepatic injury referred to bedaquiline, much lower than that referred to protionamide, pyrazinamide and para-aminosalicylic acid individually. CONCLUSIONS: Bedaquiline was generally well-tolerated with few safety concerns in this clinical patient population without any new safety signal identified. The mortality rate was generally low. These data inform significant positive effect to support the WHO recent recommendations for the wide use of bedaquiline.

Applications of MOFs as Luminescent Sensors for Environmental Pollutants.

The environmental pollution has become a serious issue because the pollutants can cause permanent damage to the DNA, nervous system, and circulating system, resulting in various incurable diseases, such as organ failure, malformation, angiocardiopathy, and cancer. The effective detection of environmental pollutants is urgently needed to keep them far away from daily life. Among the reported pollutant sensors, luminescent metal-organic frameworks (LMOFs) with tunable structures have attracted remarkable attention to detect the pollutants because of their excellent selectivity, sensitivity, and recyclability. Although lots of metal-organic framework (MOF)-based luminescent sensors have been summarized and discussed in previous reviews, the detection of environmental pollutants, especially radioactive ions and heavy metal ions, still have not been systematically presented. Here, the sensing mechanisms and construction principles of luminescent MOFs are discussed, and the state-of-the-art MOF-based luminescent sensors of environmental pollutants, including pesticides, antibiotics, explosives, VOCs, toxic gas, toxic small molecules, radioactive ions, and heavy metal ions are highlighted. This comprehensive review may further guide the development of luminescent MOFs and promote their practical applications for sensing environmental pollutants.

Photocatalytic Hydrogen Evolution Based on Cobalt-Organic Framework with High Water Vapor Adsorption.

Photocatalytic hydrogen evolution is desired to effectively alleviate the serious crisis of energy and the environment, and the utilization of low-cost photocatalysts, especially cobalt-based MOF catalysts, is meaningful, but rarely investigated. Herein, through a self-assembly strategy, we synthesized a Co clusters-based MOF (Co3-XL) by the ligand N,N'-bicyclo[2.2.2]oct-7-ene-2,3,5,6-tetracarboxdiimide bi(1,2,4-triazole), containing abundant carbonyl O atoms in the channels of the 3D skeleton, and a large porosity of 50.7%. The as-synthesized MOF can be stable in the pH range of 3-10 and shows a narrow band gap of 1.82 eV. Furthermore, its maximum amount of water absorption can reach 192 cm3/g. Under irradiation of simulated solar light, the rate of hydrogen evolution is 23.05 µmol·h-1·g-1 among 12 h with the presence of co-catalyst Pt and photosensitizer RhB. The reaction mechanism has been probed by the transient photocurrent response and steady-state photoluminescence spectra. Therefore, as a narrow band gap photocatalyst, the cobalt clusters-based MOF (Co3-XL) has potential applications for hydrogen evolution from water.

Stable Lanthanide-Organic Framework as a Luminescent Probe To Detect Both Histidine and Aspartic Acid in Water.

A three-dimensional metal-organic framework (MOF) {[Eu(L)(H2O)2]·DMF} n (1) (H3L = 2'-nitro-3,4',5-biphenyl tricarboxylic acid) was obtained by hydrothermal methods and was characterized in detail. Compound 1 contains [Eu2] binuclear units, and [Eu2] units are further linked by H3L, forming a three-dimensional structure. Stability tests suggest that compound 1 exhibits high solvent, pH, and thermal stability. Besides, we also explored the influence of pH values in the luminescence emission of 1 which shows that pH has a negligible effect on the luminescence intensity with the range of pH = 3-11. Importantly, luminescent investigations reveal that 1 can selectively detect aspartic acid or histidine among 14 amino acids with good regenerability in water. Meanwhile, the concentration of aspartic acid can be quantitatively determined. We also discuss the mechanism of luminescence quenching and enhancement in detail. Importantly, this Eu-MOF provides a MOF-based luminescence sensor to detect two amino acids for the first time.

Selectively detecting toluene and benzaldehyde by two stable lanthanide-organic frameworks as luminescent probes.

Benzene derivatives are seriously harmful to environment and human health, and sensitively detecting these compounds is of great significance but is a challenge. Hence, we designed and synthesized two luminescent lanthanide-organic frameworks, [{Ln(SIP)(H2O)4}]n, [Ln = Tb (1), Eu (2)], with high solvent and pH stability, which can be used as luminescent probes to detect toluene and benzaldehyde among various reagents, and the detection limit can reach up to 10-7 mol L-1 for toluene, and 10-6 mol L-1 for benzaldehyde. Regenerated experimental results indicate that both 1 and 2 can be used for at least five cycles with high precision. To the best of our knowledge, this is the first example of the two-dimensional regenerable luminescent sensor for toluene and benzaldehyde through luminescent quenching.

Effect of the Wnt signal-RANKL/OPG axis on the enhanced osteogenic integration of a lithium incorporated surface.

Bone remolding involves the formation of new bone by osteoblasts and the absorption of old bones by osteoclasts. Due to the vital role of osteoblasts and osteoclasts during bone regeneration, it might be feasible to promote osseointegration around the titanium implants by stimulating osteoblasts and inhibiting osteoclasts by modifying the surfaces of the implants. Lithium is used in the treatment of psychiatric patients, and it may be associated with osteogenesis. In this study, lithium was incorporated with sandblasted, large-grit and acid-etched titanium implants via a hydrothermal treatment. In vitro, the nano-scale surface enhanced the adhesion and proliferation of bone marrow mesenchymal stem cells (BMSCs). Moreover, the SLA-Li surface displayed a negative effect on the process of osteoclastogenesis. Further mechanism analysis indicated that the canonical Wnt/ß-catenin signaling pathway was activated according to the results of RT-PCR and western blotting. More importantly, the RANKL/OPG signaling axis was also involved in these effects on the SLA-Li surface. The experiments in vivo proved that the SLA-Li surface could induce the bone formation and osseointegration during the early osseointegration after the dental implant surgery. These results suggested that bone homeostasis could be manipulated by an SLA-Li surface, which implied that this new surface might serve as a promising material for clinical application in the future.

Positive effect of strontium-oxide layer on the osseointegration of moderately rough titanium surface in non-osteoporotic rabbits.

OBJECTIVES: To evaluate the effect of strontium-oxide layer on new bone formation and osseointegration of sandblasted large-grit double-acid-etched (SLA) implant. MATERIAL AND METHODS: Strontium-oxide layer on the SLA surface was produced by hydrothermal treatment using a Sr-containing solution. The surface topographies, roughness, hardness values, chemical elements and ionic release of SLA and the strontium-containing SLA (Sr-SLA) surface were measured by special instruments separately. Sixty-four SLA and Sr-SLA implants were inserted into the proximal tibiae and femoral condyles of sixteen non-osteoporotic New Zealand white rabbits. The biological effects were evaluated by removal torque (RTQ) testing and histomorphometric analysis after 3 and 6 weeks of implantation. RESULTS: The surface characteristics showed Sr-SLA surfaces with dotted nanostructures can release appropriate amount of strontium ions into surrounding tissue till 14 days. In vivo, the Sr-SLA implants presented significantly higher RTQ than SLA implants at 3 and 6 weeks (P < 0.05). The Sr-SLA implants presented higher bone-to-implant contact (BIC) than SLA implants in cortical bone at 3 and 6 weeks (P < 0.05). The bone area was slightly higher for the Sr-SLA implants at 3 and 6 weeks (P > 0.05). CONCLUSIONS: The strontium-oxide layer on the SLA surface has the potential to improve implant osseointegration in non-osteoporotic rabbits.

Long-term outcomes of osteotome sinus floor elevation without bone grafts: a clinical retrospective study of 4-9 years.

OBJECTIVE: To evaluate the long-term clinical and radiographic outcomes of dental implant placed using osteotome sinus floor elevation (OSFE) without bone grafts, and to analyze the potential influence factors of implant survival and endo-sinus bone remodeling. MATERIAL AND METHODS: A retrospective study design was adopted. The clinical and radiographic data of 96 implants in 80 patients were collected after 4-9 (mean 5.40) years follow-up. Implant failures, peri-implant marginal bone loss (MBL), and endo-sinus bone remodeling on the radiographs were evaluated. A life-table analysis was used to assess the implant survival. Statistical models were established to investigate the potential influence factors of implant survival and endo-sinus bone gain (ESBG). RESULTS: In total, nine implants in seven patients failed, giving the 9-year cumulative survival rates of 90.6% and 91.3% for implant-based analysis and patient-based analysis, respectively. The mean MBL between implant installation and the 4- and 9-year follow-up visit was 0.46 ± 0.88 and 0.50 ± 1.69 mm, respectively. The average ESBG on radiographs was 2.95 ± 1.25 and 2.16 ± 1.13 mm at the 4- and 9-year follow-up. The final ESBG was found to be positively correlated to implant protrusion length after surgery without any other factors related. The implant survival rate was significantly lower in severe atrophic site (residual bone height <5 mm). CONCLUSION: Osteotome sinus floor elevation without bone grafts is a predictable treatment modality in the long run. But it should be used with caution when the initial bone height of the edentulous site is lower than 5 mm. The final endo-sinus bone height was found to be positively correlated to implant protrusion length measured on radiographs immediately after implant installation.

Effects of storage medium and UV photofunctionalization on time-related changes of titanium surface characteristics and biocompatibility.

Storage in aqueous solution and ultraviolet (UV) photofunctionalization are two applicable methods to overcome the biological aging and increase the bioactivity of titanium. As information regarding the combined effects of storage medium and UV photofunctionalization has never been found in published literatures, this study focused on whether appropriate storage methods and UV photofunctionalization have synergistic effects on the biological properties of aged titanium surfaces. Titanium plates and discs were sandblasted and acid etched and then further prepared in five different modes as using different storage mediums (air or dH2 O) for 4 weeks and then with or without UV treatment. The surface characteristics were evaluated with scanning electron microscopy, contact angle measurements, and X-ray photoelectron spectroscopy. MC3T3-E1 cells were cultured on the surfaces, and cellular morphology, proliferation, alkaline phosphatase activity, and osteocalcin release were evaluated. The results showed that nanostructures were observed on water-stored titanium surfaces with a size of about 15 × 20 nm(2) . UV treatment was effective to remove the hydrocarbon contamination on titanium surfaces stored in either air or water. UV photofunctionalization further enhanced the already increased bioactivity of modSLA on initial cell attachment, proliferation, alkaline phosphatase activity, and osteocalcin release. Overall, UV photofunctionalization was effective in further enhancing the already increased bioactivity by using dH2 O as storage medium, and the effect of UV treatment was much more overwhelming than that of the storage medium. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 932-940, 2016.

Local blockage of EMMPRIN impedes pressure ulcers healing in a rat model.

Excessive extracellular matrix degradation caused by the hyperfunction of matrix metalloproteinases (MMPs) has been implicated in the failure of pressure ulcers healing. EMMPRIN, as a widely expressed protein, has emerged as an important regulator of MMP activity. We hypothesize that EMMPRIN affects the process of pressure ulcer healing by modulating MMP activity. In the rat pressure ulcer model, the expression of EMMPRIN in ulcers detected by Western blot was elevated compared with that observed in normal tissue. To investigate the role of EMMPRIN in regulating ulcer healing, specific antibodies against EMMPRIN were used via direct administration on the pressure ulcer. Local blockage of EMMPRIN resulted in a poor ulcer healing process compared with control ulcers, which was the opposite of our expectation. Furthermore, inhibiting EMMPRIN minimally impacted MMP activity. However, the collagen content in the pressure ulcer was reduced in the EMMPRIN treated group. Angiogenesis and the expression of angiogenic factors in pressure ulcers were also reduced by EMMPRIN local blockage. The results in the present study indicate a novel effect of EMMPRIN in the regulation of pressure ulcer healing by controlling the collagen contents and angiogenesis rather than MMPs activity.

Prevalence of consistent condom use with various types of sex partners and associated factors among money boys in Changsha, China.

INTRODUCTION: Money boys with inconsistent condom use (less than 100% of the time) are at high risk of infection by human immunodeficiency virus (HIV) or sexually transmitted infection (STI), but relatively little research has examined their risk behaviors. AIM: We investigated the prevalence of consistent condom use (100% of the time) and associated factors among money boys. METHODS: A cross-sectional study using a structured questionnaire was conducted among money boys in Changsha, China, between July 2012 and January 2013. MAIN OUTCOME MEASURE: Independent variables included socio-demographic data, substance abuse history, work characteristics, and self-reported HIV and STI history. Dependent variables included the consistent condom use with different types of sex partners. RESULTS: Among the participants, 82.4% used condoms consistently with male clients, 80.2% with male sex partners, and 77.1% with female sex partners in the past 3 months. A multiple stepwise logistic regression model identified four statistically significant factors associated with lower likelihoods of consistent condom use with male clients: age group, substance abuse, lack of an "employment" arrangement, and having no HIV test within the prior 6 months. In a similar model, only one factor associated significantly with lower likelihoods of consistent condom use with male sex partners was identified in multiple stepwise logistic regression analyses: having no HIV test within the prior six months. As for female sex partners, two significant variables were statistically significant in the multiple stepwise logistic regression analysis: having no HIV test within the prior 6 months and having STI history. CONCLUSIONS: Interventions which are linked with more realistic and acceptable HIV prevention methods are greatly warranted and should increase risk awareness and the behavior of consistent condom use in both commercial and personal relationship.

Effects of zinc-substituted nano-hydroxyapatite coatings on bone integration with implant surfaces.

OBJECTIVE: The purpose of this study was to investigate the effects of a zinc-substituted nano-hydroxyapatite (Zn-HA) coating, applied by an electrochemical process, on implant osseointegraton in a rabbit model. METHODS: A Zn-HA coating or an HA coating was deposited using an electrochemical process. Surface morphology was examined using field-emission scanning electron microscopy. The crystal structure and chemical composition of the coatings were examined using an X-ray diffractometer (XRD) and Fourier transform infrared spectroscopy (FTIR). A total of 78 implants were inserted into femurs and tibias of rabbits. After two, four, and eight weeks, femurs and tibias were retrieved and prepared for histomorphometric evaluation and removal torque (RTQ) tests. RESULTS: Rod-like HA crystals appeared on both implant surfaces. The dimensions of the Zn-HA crystals seemed to be smaller than those of HA. XRD patterns showed that the peaks of both coatings matched well with standard HA patterns. FTIR spectra showed that both coatings consisted of HA crystals. The Zn-HA coating significantly improved the bone area within all threads after four and eight weeks (P<0.05), the bone to implant contact (BIC) at four weeks (P<0.05), and RTQ values after four and eight weeks (P<0.05). CONCLUSIONS: The study showed that an electrochemically deposited Zn-HA coating has potential for improving bone integration with an implant surface.

Bone response to the multilayer BMP-2 gene coated porous titanium implant surface.

OBJECTIVES: Evaluate hBMP-2 expression following gene delivery from plasmid multilayers formed on sandblasted titanium in vitro and bone formation around similarly prepared implant surfaces in vivo. MATERIALS AND METHODS: Multilayers of cationic lipid/rhBMP-2 plasmid DNA complex (LDc) and anionic hyaluronic acid (HA) was assembled on sandblasted-dual acid etched pure titanium disks or implant surfaces using layer-by-layer (LBL) assembly. Gene delivery and hBMP-2 expression in cells exposed to the LDc multilayers was measured in vitro. To determine the effect of BMP delivery from such multilyaers in vivo, roughened implants coated with BMP-2 LDc multilayers or uncoated control implants (n = 15 for both) were implanted in the femurs of NZW rabbits. After 2, 4, 8 weeks, femurs were retrieved and prepared for histomorphometric evaluation (n = 5 rabbits per time point). RESULTS: MC3T3-E1 cells cultured directly on the BMP-2 LDc coated titanium disks showed EGFP and hBMP-2 expression after 48 h in culture. Increased gene delivery occurred by increasing the number of assembly layers when cells were cultured for 48 h. Cells cultured on LDc coated surfaces had significantly higher cell viability than control cells cultured on uncoated porous titanium surfaces. Histologic observation of the implants showed that after 4 weeks healing, the bone to implant contact (BIC) on the LDc coated surface was much lower than that on the control surface, but didn't reach significant. In contrast, the percentage of bone within the implant's threads was significantly higher than the control group (P = 0.047). CONCLUSION: The BMP-2 gene coated sandblasted dual acid etched titanium implants slightly accelerated early bone formation around implants.

Osteoblast responses to thin nanohydroxyapatite coated on roughened titanium surfaces deposited by an electrochemical process.

PURPOSE: The purpose of this study was to investigate in vitro osteoblast responses to the thin nano-hydroxyapatite (HA) coating on porous implant surfaces. MATERIALS AND METHODS: Surface characteristics of nano-HA coating were evaluated by x-ray diffractometer (XRD) and Fourier transform infrared spectroscopy (FTIR). Murine preosteoblast cell (MC3T3-E1) proliferation, alkaline phosphatase (ALP) activity, and osteocalcin release on nano-HA coated surfaces were compared with HA-coated surfaces. RESULTS: The XRD pattern demonstrated that the peak of nano-HA coating matched well with the standard HA patterns. FTIR spectra also showed that the coating consisted of pure HA crystals. Significant increases in cell proliferation, total protein on day 7, ALP activity on day 14 and day 21, and osteocalcin production on day 21 (P < .05) were observed for nano-HA coated surfaces. CONCLUSIONS: It was concluded that thin nano-HA coating, deposited by the electrochemical process, improved proliferation and differentiation of osteoblasts.

Effect of strontium-substituted nanohydroxyapatite coating of porous implant surfaces on implant osseointegration in a rabbit model.

PURPOSE: This study investigated the effects of a strontium-substituted nanohydroxyapatite (Sr-HA) coating, deposited onto porous implant surfaces using an electrochemical process, on implant osseointegration in a rabbit model. MATERIALS AND METHODS: The surfaces were analyzed by field-emission scanning electron microscopy, x-ray diffractometry (XRD), Fourier transform infrared spectroscopy (FT-IR), a portable surface roughness tester, and inductively coupled plasma atomic emission spectroscopy (ICP-AES). Thirty implants (half HA-coated and half Sr-HA-coated) were inserted into femurs of 15 rabbits. After 2, 4, and 8 weeks, the femurs were retrieved and prepared for histomorphometric evaluation. RESULTS: Microscopic examination showed a surface topography of rodlike crystals on both surfaces. XRD and FT-IR showed that the phase of the deposits was HA. No differences were found in surface roughness between the two groups. ICP-AES showed that the Sr/(Ca+Sr) molar ratio of Sr-HA coating was 10.1 mol%. Histologic observation showed that new bone appeared on both surfaces after 2 weeks and became mature after 8 weeks. Histomorphometric analysis showed no differences between the two groups in bone-to-implant contact at 2 weeks or in bone area within all threads at 2 and 4 weeks. The Sr-HA coated group had significantly higher bone-to-implant contact at 4 and 8 weeks. Significant differences were also found in bone area at 8 weeks. CONCLUSION: The present study showed that this Sr-HA coating, deposited using an electrochemical process, has the potential to enhance implant osseointegration.

Osteoblast response to porous titanium surfaces coated with zinc-substituted hydroxyapatite.

BACKGROUND: The aims of this study were to deposit a zinc-hydroxyapatite (Zn-HA) coating on titanium surfaces by using the electrochemical process and investigate the cell response to the Zn-HA-coated titanium surface. STUDY DESIGN: Surface characteristics were evaluated by scanning electron microscopy (SEM) and inductively coupled plasma atomic emission spectroscopy (ICP-AES). Murine preosteoblast cell (MC3T3-E1) proliferation, alkaline phosphatase (ALP) activity, and osteocalcin release on Zn-HA-coated surfaces were compared with HA-coated surfaces. RESULTS: Field-emission SEM observation showed rod-like HA crystals with a hexagonal cross-section on the HA-coated surface, although the hexagon of the cross-section of Zn-HA crystals became irregular. ICP-AES analysis showed that Zn was present in the Zn-HA coatings at a Zn/(Ca+Zn) molar ratio of 1.04%. Significant increases in cell proliferation, ALP activity on day 7, and osteocalcin production on day 14 (P < .05) were observed for Zn(2+)-containing HA-coated surfaces. CONCLUSIONS: The present study showed that a Zn-HA coating deposited by using the electrochemical process enhances proliferation and differentiation of osteoblasts, which has the potential benefit to enhance implant osseointegration.

Influence of multilayer rhBMP-2 DNA coating on the proliferation and differentiation of MC3T3-E1 cells seeded on roughed titanium surface.

For bone morphogenetic protein (BMP) gene therapy to be a viable approach for enhancing implant osseointegration clinically, requires the development of efficient nonviral delivery vectors that can coat the implant. This study evaluated a multilayer cationic liposome-DNA complex (LDc) coating as a delivery vehicle for recombinant human BMP-2 (rhBMP-2). Multilayered coatings, comprising hyaluronic acid (HA) and LDc, were fabricated onto titanium using a layer-by-layer (LBL) assembly technique. Preosteoblastic MC3T3-E1 cells were cultured on the roughened titanium surfaces coated with multilayers of HA/LDc, or on uncoated or HA/liposome only surfaces as controls. The amount of rhBMP-2 secreted by the MC3T3-E1 cells and the effect of the various surfaces on cell viability, proliferation, alkaline phosphatase (ALP) activity, osteocalcin (OC) secretion, and calcium deposition were evaluated. Messenger RNA levels of OC, ALP, Runx2, and Osx were also investigated. The results demonstrated that rhBMP-2 protein secreted into culture medium at 3 days was significantly higher than control groups. MC3T3-E1 cells cultured on the HA/LDc coating displayed significantly higher ALP activity and OC secretion at 7 days and 14 days culture, respectively. MC3T3-E1 cells cultured on HA/LDc upregulated expression of the osteoblast differentiation markers, especially on days 12 for OC and on days 6 and 12 for ALP and Osx. In conclusion, MC3T3-E1 cell cultured on the multilayer HA/LDc coating surface can secret rhBMP-2 protein and the protein levels were effective in inducing early osteogenic differentiation.

Fluorescence microscopic analysis of bone osseointegration of strontium-substituted hydroxyapatite implants.

The purpose of this study was to analyze the effect of strontium-substituted hydroxyapatite (Sr-HA) on bone osseointegration of the implants using fluorescence microscopy. We allocated 20 implants to two groups: Sr-HA group and HA group. Electrochemically deposited HA and Sr-HA coatings were applied onto the implants separately. All the implants were inserted into femur bone of rabbits. Oxytetracycline hydrochloride, alizarin-complexon, and calcein green were respectively administered 7, 28, and 46 d after the implantation. After eight weeks, femurs were retrieved and prepared for the fluorescence microscopy observation. We analyzed the bone mineral apposition rates (MARs), bone area ratios (BARs), and bone to implant contact (BIC) of the two groups. Fluorescence microscopic observation showed that all groups exhibited extensive early peri-implant bone formation. The MAR of the Sr-HA group was greater than that for pure HA from 7 to 28 d after implantation, but no significant difference was found at later stage. And the BIC showed difference at 7 and 28 d compared with pure HA. We concluded that Sr-HA coating can improve the bone osseointegration of the implant in the early stage compared with the HA coating.