Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors

AIM:To characterize spectral-domain optical coherence tomography(SD-OCT)features of chorioretinal folds in orbital mass imaged using enhanced depth imaging(EDI).METHODS:Prospective observational case-control study was conducted in 20 eyes of 20 patients,the uninvolved eye served as a control.All the patients underwent clinical fundus photography,computed tomography,EDI SDOCT imaging before and after surgery.Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5;the remaining patients underwent tumor excision.Patients were followed 1 to 14mo following surgery(average follow up,5.8mo).RESULTS:Visual acuity prior to surgery ranged from 20/20 to 20/200.Following surgery,5 patients’visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10(range 4 to 26 letters).Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery.Following surgical excision,photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients.CONCLUSION:Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis.Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.

Mechanically strong porous bioceramic tubes facilitate large segmental bone defect repair by providing long-term structurally stability and promoting osteogenesis

Mechanically strong magnesium-doped Ca-silicate bioceramic scaffolds have many advantages in repairing large segmental bone defects.Herein we combine β-TCP with 6 mol%magnesium-doped calcium silicate(Mg6)at three different ratios(TCP,TCP+15%Mg6,TCP+85%Mg6)to find an appropriate ratio which can exert considerable influence on bone regeneration.In this study,the bioceramic scaffolds were assessed for mechanical strength,bioactive ion release,biocompatibility,and osteogenic capacity through in vitro testing.Additionally,the potential for promoting bone regeneration was investigated through in vivo implantation of porous tube-like scaffolds.The results showed that the compressive strength increased with the augmentation of Mg6 component.Especially the compressive strength of the TCP+85%Mg6 group reached 38.1±3.8 MPa,three times that of the other two groups.Furthermore,extensive in vivo investigations revealed that the TCP+85%Mg6 bioceramic scaffolds were particularly beneficial for the osteogenic capacity of critical-sized femoral defects(20 mm in length).Altogether,magnesium doping in bioceramic implants is a promising strategy to provide stronger mechanical support and enhance osteogenesis to accelerate the repair of large defects.

Graphene oxide coated three-dimensional printed biphasic calcium phosphate scaffold for angiogenic and osteogenic synergy in repairing critical-size bone defect

The custom-tailored medicine requires a developmental strategy that integrates excellent osteogene-sis with mechanical stability to enhance the reconstruction of the critical-size bone defect(CSBD)and the healing process in weight-bearing bone.We prepared three-dimensional(3D)printed biphasic cal-cium phosphate(BCP)scaffolds composited with nano-graphene oxide(GO).The biological effects of the GO/BCP composite scaffolds could induce the differentiation of rat bone marrow stem cells(BM-SCs)and the migration of human umbilical vein endothelial cells(HUVECs)for bone repair.The proper ratio of GO in the composite scaffold regulated the composites’surface roughness and hydrophilicity to a suitable range for the adhesion and proliferation of BMSCs and HUVECs.Besides,the GO/BCP composite scaffold increased osteogenesis and angiogenesis by activating BMP-2,RUNX-2,Smad1/4,and VEGF.The customized intramedullary nail combined with GO/BCP scaffold was applied to repair CSBD(2.0 cm in length)in a beagle femur model.This fixation strategy was confirmed by finite element analysis.In vivo,the results indicated that the custom-made internal fixation provided sufficient stability in the early stage,ensuring bone healing in a considerable mechanical environment.At 9 months postoperatively,longitudi-nal bony union and blood vessels in osteon were observed in the CSBD area with partial degradation in the 0.3%GO/BCP group.In the three-point bending test,the ultimate load of 0.3%GO/BCP group reached over 50%of the normal femur at 9 months after repair.These results showed a promising application of osteogenic GO/BCP scaffold and custom-made intramedullary nails in repairing CSBD of the beagle femur.This effective strategy could provide an option to treat the clinical CSBD in weight-bearing bones.

Nanocomposites and bone regeneration

This manuscript focuses on bone repair/regeneration using tissue engineering strategies, and highlights nanobiotechnology developments leading to novel nanocomposite systems. About 6.5 million fractures occur annually in USA, and about 550,000 of these individual cases required the application of a bone graft. Autogenous and allogenous bone have been most widely used for bone graft based therapies; however, there are significant problems such as donor shortage and risk of infection. Alternatives using synthetic and natural biomaterials have been developed, and some are commercially available for clinical applications requiring bone grafts. However, it remains a great challenge to design an ideal synthetic graft that very closely mimics the bone tissue structurally, and can modulate the desired function in osteoblast and progenitor cell populations. Nanobiomaterials, specifically nanocomposites composed of hydroxyapatite （HA） and/or collagen are extremely promising graft substitutes. The biocomposites can be fabricated to mimic the material composition of native bone tissue, and additionally, when using nano-HA （reduced grain size）, one mimics the structural arrangement of native bone. A good understanding of bone biology and structure is critical to development of bone mimicking graft substitutes. HA and collagen exhibit excellent osteoconductive properties which can further modulate the regenerative/ healing process following fracture injury. Combining with other polymeric biomaterials will reinforce the mechanical properties thus making the novel nano-HA based composites comparable to human bone. We report on recent studies using nanocomposites that have been fabricated as particles and nanofibers for regeneration of segmental bone defects. The research in nanocomposites, highlight a pivotal role in the future development of an ideal orthopaedic implant device, however further significant advancements are necessary to achieve clinical use.

Comparing the regeneration potential between PLLA/Aragonite and PLLA/ Vaterite pearl composite scaffolds in rabbit radius segmental bone defects

Mussel-derived nacre and pearl,which are natural composites composed CaCO3 platelets and interplatelet organic matrix,have recently gained interest due to their osteogenic potential.The crystal form of CaCO3 could be either aragonite or vaterite depending on the characteristics of mineralization template within pearls.So far,little attention has been paid on the different osteogenic capacities between aragonite and vaterite pearl.In the current work,aragonite or vaterite pearl powders were incorporated into poly-L-lactic acid(PLLA)scaffold as bio-functional fillers for enhanced osteogenesis.In intro results revealed that PLLA/aragonite scaffold possessed stronger stimulatory effect on SaOS-2 cell proliferation and differentiation,evidenced by the enhanced cell viability,alkaline phosphatase activity,collagen synthesis and gene expressions of osteogenic markers including osteocalcin,osteopotin and bone sialoprotein.The bone regeneration potential of various scaffolds was evaluated in vivo employing a rabbit critical-sized radial bone defect model.The X-ray and micro-CT results showed that significant bone regeneration and bridging were achieved in defects implanted with composite scaffolds,while less bone formation and non-bridging were found for pure PLLA group.Histological evaluation using Masson's trichrome and hematoxylin/eosin(H&E)staining indicated a typical endochondral bone formation process conducted at defect sites treated with composite scaffolds.Through three-point bending test,the limbs implanted with PLLA/aragonite scaffold were found to bear significantly higher bending load compared to other two groups.Together,it is suggested that aragonite pearl has superior osteogenic capacity over vaterite pearl and PLLA/aragonite scaffold can be employed as a potential bone graft for bone regeneration.

Electroactive barium titanate coated titanium scaffold improves osteogenesis and osseointegration with low-intensity pulsed ultrasound for large segmental bone defects

For large segmental bone defects,porous titanium scaffolds have some advantages,however,they lack electrical activity which hinders their further use.In this study,a barium titanate(BaTiO3)piezoelectric ceramic was used to modify the surface of a porous Ti6Al4V scaffold(pTi),which was characterized by scanning electron microscopy,energy dispersive spectroscopy,X-ray photoelectron spectroscopy,and roughness and water contact angle analyses.Low intensity pulsed ultrasound(LIPUS)was applied in vitro and in vivo study.The activity of bone marrow mesenchymal stem cells,including adhesion,proliferation,and gene expression,was significantly superior in the BaTiO3/pTi,pTi+LIPUS,and BaTiO3/pTi+LIPUS groups than in the pTi group.The activity was also higher in the BaTiO3/pTi+LIPUS group than in the BaTiO3/pTi and pTi+LIPUS groups.Additionally,micro-computed tomography,the mineral apposition rate,histomorphology,and the peak pull-out load showed that these scaffold conditions significantly enhanced osteogenesis and osseointegration 6 and 12 weeks after implantation in large segmental bone defects in the radius of rabbits compared with those resulting from the pTi condition.Consequently,the improved osteogenesis and osseointegration make the BaTiO3/pTi+LIPUS a promising method to promote bone regeneration in large segmental bone defects for clinical application.

Optimal regenerative repair of large segmental bone defect in a goat model with osteoinductive calcium phosphate bioceramic implants

So far,how to achieve the optimal regenerative repair of large load-bearing bone defects using artificial bone grafts is a huge challenge in clinic.In this study,a strategy of combining osteoinductive biphasic calcium phosphate(BCP)bioceramic scaffolds with intramedullary nail fixation for creating stable osteogenic microenvironment was applied to repair large segmental bone defects(3.0 cm in length)in goat femur model.The material characterization results showed that the BCP scaffold had the initial compressive strength of over 2.0 MPa,and total porosity of 84%.The cell culture experiments demonstrated that the scaffold had the excellent ability to promote the proliferation and osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells(BMSCs).The in vivo results showed that the intramedullary nail fixation maintained the initial stability and structural integrity of the implants at early stage,promoting the osteogenic process both guided and induced by the BCP scaffolds.At 9 months postoperatively,good integration between the implants and host bone was observed,and a large amount of newborn bones formed,accompanying with the degradation of the material.At 18 months postoperatively,almost the complete new bone substitution in the defect area was achieved.The maximum bending strength of the repaired bone defects reached to the 100% of normal femur at 18 months post-surgery.Our results demonstrated the good potential of osteoinductive BCP bioceramics in the regenerative repair of large load-bearing bone defects.The current study could provide an effective method to treat the clinical large segmental bone defects.

The effect of different coatings on bone response and degradation behavior of porous magnesium-strontium devices in segmental defect regeneration

Regeneration of long-bone segmental defects remains a challenge for orthopedic surgery.Current treatment options often require several revision procedures to maintain acceptable alignment and achieve osseous healing.A novel hollow tubular system utilizing magnesium-strontium(Mg-Sr)alloy with autogenous morselized bone filled inside to repair segmental defects was developed.To improve the corrosion and biocompatible properties,two coatings,Ca-P and Sr-P coatings,were prepared on surface of the implants.Feasibility of applying these coated implants was systematically evaluated in vitro and in vivo,and simultaneously to have a better understanding on the relationship of degradation and bone regeneration on the healing process.According to the in vitro corrosion study by electrochemical measurements,greater corrosion resistance was obtained for Ca-P coated sample,and attributed to the double-layer protective structure.The cytotoxicity and alkaline phosphatase(ALP)assays demonstrated enhanced bioactivity for Sr-P coated group because of the long-lasting release of beneficial Sr^(2+).At 12 weeks post-implantation with Mg-Sr alloy porous device,the segmental defects were effectively repaired with respect to both integrity and continuity.In addition,compared with the Ca-P coated implant,the Sr-P coated implant was more proficient at promoting bone formation and mineralization.In summary,the Sr-P coated implants have bioactive properties and exceptional durability,and promote bone healing that is close to the natural rate,implying their potential application for the regeneration of segmental defects.

Three-fin acetabular prosthesis for superior acetabular bone defects： a three-dimensional finite element analysis

Background Given that three-dimensional finite element models have been successfully used to analyze biomechanics in orthopedics-related research, this study aimed to establish a finite element model of the pelvic bone and three-fin acetabular component and evaluate biomechanical changes in this model after implantation of a three-fin acetabular prosthesis in a superior segmental bone defect of the acetabulum.

Application of Acetabular Reinforcement Ring with Hook for Correction of Segmental Acetabular Rim Defects during Total Hip Arthroplasty Revision

This study investigated the biomechanical micro-motion associated with the application of acetabular reinforcement ring with hook （Ganz ring） for the correction of segmental acetabular rim defects, by finite element analysis. The objective was to determine whether the Ganz ring is suitable for correcting segmental acetabular rim defects at different regions during total hip arthroplasty revision as well as the number of screws required to fix the Ganz ring. A finite element model of the hip joint was generated to simulate and evaluate the insertion and fixation of the Ganz ring and acetabular cup in the context of segmental rim defects in the anterior column, superior portion, and posterior column. Micro-motion was the greatest in the posterior column defect and the least in the anterior column defect. However, the peak stress distribution on the remaining portion of the acetabular rim was the highest in the superior portion defect, following the pos- terior column defect and anterior column defect. Increasing the number of fixations of the Ganz ring did not decrease the micro-motion. We found that the Ganz ring effectively provided biomechanical stability during the reconstruction of the segmental rim defect as long as the screws fixed the Ganz ring well to the host bone.

Segmental long bone regeneration guided by degradable synthetic polymeric scaffolds

Recent developments in synthetic bone grafting materials and adjuvant therapeutic agents have opened the door to the regenerative reconstruction of critical-size long bone segmental defects resulting from trauma,osteoporotic fractures or tumour resections.Polymeric scaffolds with controlled macroporosities,degradability,useful surgical handling characteristics,and the ability to deliver biotherapeutics to promote new bone ingrowth have been developed for this challenging orthopaedic application.This review highlights major classes of degradable synthetic polymers and their biomineral composites,including conventional and amphiphilic polyesters,polyanhydrides,polycarbonates,and polyethylene glycol-based hydrogels,that have been explored for the regenerative reconstruction of critical-size long bone segmental defects over the past two decades.The pros and cons of these synthetic scaffold materials are presented in the context of enabling or impeding the functional(mechanical and radiographic)repair of a long bone segmental defect,with the long bone regeneration outcomes compared with healthy long bone controls or results achieved with current grafting standards.

Application of Novel Design Bone Grafting for Treatment of Segmental Acetabular Rim Defects During Revision Total Hip Arthroplasty

The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was reconstructed according to computed tomography images based on a healthy patient without any peri-acetabular bony defect according to the American Academy of Orthopedic Surgeons(AAOS).The FEA model of acetabular bone deficiency was performed to simulate and evaluate the mechanical performances of the grafts in different geometric structures,with the use of fixation implants(screws),along with the stress distribution and the relative micromotion of graft models.The stress distribution mainly concentrated on the region of contact of the screws and superolateral bone.Among the different structures,the mortise-tenone structure provided better relative micromotion,with suitable biomechanical property even without the use of screws.The novel grafting structures could provide sufficient biomechanical stability and bone remodeling,and the mortise-tenone structure is the optimal treatment option for acetabulum reconstruction.

Tackling bone loss of the lower extremity:vascularized bone grafting

Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several techniques have been described in the literature for the management of these bony defects,including non-vascularized bone grafts,vascularized bone grafts and distraction osteogenesis.Herein,the authors review the role of vascularized bone grafts in the management of post-traumatic bone loss in the lower extremity.