A review of complications of polyacrylamide hydrogel injection

Once a popular injectable filler,polyacrylamide hydrogel(PAAG)has been banned in China since 2006 due to its unclear safety and long-term complications.However,it is still being used worldwide because of its huge commercial profit,leading to emerging complications and an urgent need for standardized clinical management.This review aimed to assess the properties,safety,and complications of PAAG and treatment strategies for its removal.

A pH-sensitive Modified Polyacrylamide Hydrogel

A pH-sensitive modified polyacrylamide hydrogel was prepared by two steps and the modified polyacrylamide was characterized by ^1HNMR spectrum. The surface morphology and swelling behavior of the hydrogels were investigated.

Determination of Residual Acrylamide in Medical Polyacrylamide Hydrogel by High Performance Liquid Chromatography tandem Mass Spectroscopy

Objective To determine residual acrylamide in medical polyacrylamide hydrogel by high performance liquid chromatography tandem mass spectroscopy （HPLC-MS）. Methods After 13C3 labeled acrylamide was added, the sample was extracted with water and then cleaned up with ExtrelutTM 20. The polyacrylamide hydrogel sample and 20 clinical cases were analyzed by HPLC-MS/MS and isotope dilution quantifying technique in selected reaction monitoring （SRM） mode. Results Acrylamide was separated from polyacrylamide hydrogel. The concentration of acrylamide in polyacrylamide hydrogel ranged from 3.9×10^-9 to 3.1×10^- 8g/L in the 20 clinical cases. The peak area was favorable linear and the range was up to 3 000 μg/L. The recovery rate was 103.1% with a relative standard deviation （RSD） of 6.20%, when the mark level was 50 lag/L. Conelusion HPLC-MS is a rapid, accurate, and sensitive method for the determination of residual acrylamide in medical polyacrylamide hydrogel.

ADDITIVE-INDUCED ENHANCEMENT OF OPTICAL CLARITY OF POLYACRYLAMIDE HYDROGEL

The aqueous polymerization of acrylamide and crosslinking with N,N-methylenebisacrylamide afforded hydrogelsdisplaying high levels of light scattering (poor optical clarity). Enhancement of the optical clarity within a polyacrylamide(PAm) hydrogel was accomplished through the implementation of 'refractive index matching'. Water-soluble additives wereutilised to better match the refractive index inhomogeneities throughout a given hydrogel. This resulted in lower lightscattering within the system and hence improved clarity. Amino acids, sugars, polymers, and other water-soluble additivessuch as glycerol were investigated by this methodology. Most additives investigaed displayed potential for effectivelyreducing the light scattering within a PAm hydrogel as a function of increased additive concentration. On increasing therefractive index of the water medium, the overall refractive index of a PAm hydrogel was also observed to increase. Thisprovided a quantitative means of determining the effectiveness of a given additive for improving the optical clarity within ahydrogel.

Swelling Behavior of Polyacrylamide Hydrogels near Phase Transition

Hydrogels based on acrylamide (AA) and sodium methacrylate (NMA) as ionic monomer were prepared by solution polymerization using N,N’-methylenebis(acrylamide) (MBA) or ethylene glycol dimethacrylate (EGMA) as crosslinkers and Ammonium Persulfate (APS) and N,N,N’,N’-Te-tramethyl-ethylenediamine (TMEDA) as initiators. Swelling behavior was greatly affected by NMA content near phase transition. Increasing ionic monomer concentration compared to total monomer one led to high expansion in water, oscillating around 285 g/g for MBA and 325 g/g for EGMA crosslinker, above 20% of NMA. Dynamic Light Scattering experiments were performed and, for both crosslinkers, the dynamic correlation length (ξ) decreased with increasing NMA content, contributing to diminish hydrogels spatial inhomogeneities.

SWELLING EQUILIBRIUM OF NONIONIC POLYACRYLAMIDE HYDROGEL IN AQUEOUS SALT SOLUTIONS

A series of nonionic polyacrylamide hydrogels, using acrylamide as monomer and N,N＇-methylene diacrylamide as crosslinking agent, were prepared by the free radical polymerization in aqueous solution. Swelling equilibria for the gels were carried out in aqueous solutions of NaCl, KCI, CaCl2, Na2HPO4 and K2HPO4 with concentration ranging from 10^-3 to 5mol/kgH2O at 25 ℃. Experimental results revealed that the chlorides and phosphates cause a different behavior at higher salt concentration. The swelling ratio increases with increasing concentration of chlorides salts, while decreases with the increased phosphates salt concentration. The phenomena seem to be related to the different interactions of chloride and hydrogen phosphate ions with the network groups. Furthermore, the effects of different concentration of crosslinking agent and total monomers on gel swelling performance were also investigated.

Tough Semi-interpenetrating Polyvinylpyrrolidone/Polyacrylamide Hydrogels Enabled by Bioinspired Hydrogen-bonding Induced Phase Separation

Semi-interpenetrating(semi-IPN)hydrogels formed by the continuous interpenetration of cross-linked polymer network and linear non-crosslinked polymer with multifunctionality are widely used in biomedical and other fields.However,the negative impact of linear polymer on the homogeneity of the cross-linked network often leads to a decrease in the mechanical properties of semi-IPN hydrogels and severely limits their applications.Herein,a bioinspired hydrogen-bonding induced phase separation strategy is presented to construct the tough semi-IPN polyvinylpyrrolidone/polyacrylamide hydrogels(named PVP/PAM hydrogels),including the linear polymer polyvinylpyrrolidone(PVP)and cross-linked polyacrylamide(PAM)network.The resultant PVPx/PAM hydrogels exhibit unique phase separation induced by the hydrogen bonding between PVP and PAM and affected by the amount of substance of PVP.Meanwhile,the phase separation of PVPx/PAM hydrogels results in excellent mechanical properties with a strain of 2590%,tensile strength of 0.28 MPa and toughness of 2.17 MJ/m^(3).More importantly,the hydrogen bonding between PVP and PAM firstly disrupts to dissipate energy under external forces,so the PVPx/PAM hydrogels exhibit good self-recovery properties and outperform chemically cross-linked PAM hydrogels in impact resistance and damping applications.It is believed that the PVPx/PAM hydrogels with hydrogen-bonding induced phase separation possess more potential application prospects.

Fabrication of Core-Shell Hydrogel Bead Based on Sodium Alginate and Chitosan for Methylene Blue Adsorption

A novel core-shell hydrogel bead was fabricated for effective removal of methylene blue dye from aqueous solutions.The core,made of sodium alginate-g-polyacrylamide and attapulgite nanofibers,was cross-linked by Calcium ions(Ca^(2+)).The shell,composed of a chitosan/activated carbon mixture,was then coated onto the core.Fourier transform infrared spectroscopy confirmed the grafting polymerization of acrylamide onto sodium alginate.Scanning electron microscopy images showed the core-shell structure.The core exhibited a high water uptake ratio,facilitating the diffusion of methylene blue into the core.During the diffusion process,the methylene blue was first adsorbed by the shell and then further adsorbed by the core.Adsorption tests showed that the coreshell structure had a larger adsorption capacity than the core alone.The shell effectively enhanced the adsorption capacity to methylene blue compared to the single core.Methylene blue was adsorbed by activated carbon and chitosan in the shell,and the residual methylene blue diffused into the core and was further adsorbed.

Design,synthesis and characterization of a novel pH-sensitive hydrogel

A novel degradable pH-sensitive hydrogel with pendent carboxyl groups was designed and synthesized from ethylenediaminetetraacetic dianhydride （EDTAh） and butanediamine （BDA） with dicyclohexylcarbodiimide （DCC） as a condensating agent and BDA as a crosslinking agent. The obtained polymers were characterized by ^13C NMR, ^1H NMR and FTIR. The swelling experiments of the hydrogel in pH 3, 7, and 12 media indicated much higher swelling ratio in pH 12 media than in pH 3 and pH 7 media, exhibiting sound pH sensitivity. The pH sensitivity of this type of hydrogel may be regulated through controlling the type and the dose of the crosslinking agent.

Characterization of pH-sensitive Poly (acrylic acid-co-N-vinyl-2-pyrrolidone) Hydrogels Prepared by Gamma Radiation

The pH-sensitive copolymer hydrogels were prepared with the monomers of acrylic acid and N-vinyl-2-pyrrolidone based on gamma radiation technique. The morphology of the hydrogels was monitored by using scanning electron microscope. The influence of absorbed dose, monomer composition and concentration on the swelling ratio (SR) of the hydrogels were investigated in detail. The effect of pH and temperature of the swelling medium on the swelling behavior of the hydrogels were also examined. The results show that the SR of the copolymer hydrogels decreases with the monomer concentration and absorbed dose increasing. The copolymer hydrogels show a better pH-sensitive behavior. In alkaline solution, the SR of the hydrogels is much higher than in acid solution.

Preparation and Characteristics of a pH-sensitive Glucose-based Hydrogel

With glucose as the template compound,a p H-sensitive hydrogel was prepared by polymerization of the modified glucose,acrylamide,and acrylic acid.The porous hydrogel showed the highest swelling ratio of 42.7 g/g at p H=7.4 and the best adsorption of methylene blue at p H=7.The Langmuir isotherm fitted very well to the equilibrium adsorption data with the maximum adsorption capacity of 49.1 mg/g.The adsorption kinetics were well described by the pseudo 2^(nd) order model.Adsorption studies suggested that the p H-sensitive glucose-based hydrogel could be used as an adsorbent for the removal of methylene blue from wastewater.Other applications of the hydrogel are on the way,such as scaffolding in the biomedical field and soil conditioning in agriculture.

Synthesis of pH-Sensitive Hydrogel Based on Starch-Polyacrylate Superabsorbent

In this article, we synthesize of a novel starch-based superabsorbent hydrogel via graft copolymerization of mixtures of acrylic acid (AA) and 2-Hydroxy ethyl methacrylate (HEMA) onto starch backbones. The polymerization reaction was carried out in an aqueous medium and in the presence of ammonium persulfate (APS) as an initiator and N,N’-methylene bisacrylamide (MBA) as a crosslinker. The hydrogel structures were confirmed by FTIR spectroscopy. Furthermore, the swelling of superabsorbing hydrogels was examined in solutions with pH values ranging between 1 and 13. It showed a reversible pH-responsive behavior at pHs 2 and 8. This on-off switching behavior makes the synthesized hydrogels as an excellent candidate for controlled delivery of bioactive agents. A proposed mechanism for hydrogel formation was suggested and the structure of the product was established using FTIR and SEM spectroscopies.

Polyacrylamide gel migration after injection for breast augmentation:A case report

Polyacrylamide hydrogel(PAAG)was once considered a safe,reliable,and compatible injected filler and was widely used in breast augmentation,rhinoplasty,and other cosmetic surgeries.However,numerous complications,such as implant migration,have been observed after PAAG injections.Herein,we report a rare case of distant implant migration after PAAG injection for breast augmentation in which the material became displaced along the abdominal wall to the perineum and pelvic extraperitoneal space.After a well-prepared preoperative evaluation involving magnetic resonance imaging(MRI)and computed tomography(CT)examinations and threedimensional hologram,debridement surgery was performed to remove the injected material.After the operation,the patient was followed up for two years and was not scheduled for a second operation.Postoperative complications of breast augmentation after PAAG injection,especially gel migration,still affect thousands of patients.Once material migration occurs,surgical removal becomes difficult.Early diagnosis and treatment are recommended.

Transparent h-BN/polyacrylamide nanocomposite hydrogels with enhanced mechanical properties

In this study, a facile way has been proposed to prepare transparent, tough and flexible polyacrylamide （PAM） hydrogels which is composed of a dually crosslinked single network by chemical crosslinking of N,N＇-methylenebisacrylamide （BIS） and physical crosslinking of hydrophilic hexagonal boron nitride （h- BN） nanosheets. The resulting h-BN/PAM nanocomposite hydrogels are highly transparent, and exhibit significantly enhanced mechanical properties compared to the dark （GO）/PAM nanocomposite hydrogels or chemical crosslinking PAM hydrogels. Thus it opens up new opportunities for developing next- generation transparent, tough and flexible hydrogels that hold great promise in such important applications as light responsive soft robot and liquid microlenses.

Self-healing carrageenan-driven polyacrylamide hydrogels for strain sensing

Conductive hydrogels have attached considerable attention due to their good stretchability,excellent conductivity when they are applied in soft electronics. However,to fabricate a flexible hydrogel sensor with excellent toughness and good self-healing properties remains a challenge. In this work,we assembled a dual physical-crosslinking(DPC) ionic conductive polyacrylamide/carrageenan double-network(DN) hydrogel. This hydrogel has excellent fracture tensile stress and toughness,and demonstrates rapid self-recovery and self-healing ability due to the unique dual physical-crosslinking structures. Besides,the hydrogel is highly conductive by adding some conductive ions. As a result,the hydrogel-based sensor can stably detect human motions and physiological signals. The work provides novel ideas for the development of flexible sensing devices.

pH-sensitive KHA/CMC-Fe^(3+)@CS hydrogel loading and the drug release properties of riboflavin

To improve drug utilization,reduce the drug administration frequency,increase the release time,and reduce the drug side effects in the human body,we prepared(KHA/CMC-Fe^(3+))@CS hydrogel spheres using green and natural potassium humate(KHA),carboxymethyl cellulose(CMC),and chitosan(CS)as raw materials and Fe3+as a crosslinking agent,and loaded them with riboflavin for drug sustainedrelease study using the drop ball method.The tests with FTIR,SEM,TG,and X-ray diffractometer showed that the coordination among KHA,CMC,and Fe^(3+)formed a three-dimensional network structure,where cs was encapsulated on the surface of the hydrogel spheres via noncovalent bonding,resulting in good thermal stability.The stability,drug loading,swelling,and in vitro release of the(KHA/CMC-Fe^(3+))@CS hydrogel spheres were investigated.The results showed that the hydrogel spheres were significantly pH-sensitive,with 11.16 g/g higher swelling in an alkaline environment(pH=7.4)than that in an acidic environment(pH=1.2).The swelling and drug release process of the hydrogel spheres were analyzed using mathematical models,concluding that the hydrogel swelling follows Schott second-order swelling kinetics,and the drug release mechanism was Fickian delivery mode.

A double-network hydrogel for the dynamic compression of the lumbar nerve root

Current animal models of nerve root compression due to lumbar disc herniation only assess the mechanical compression of nerve roots and the inflammatory response. Moreover, the pressure applied in these models is static, meaning that the nerve root cannot be dynamically compressed. This is very different from the pathogenesis of lumbar disc herniation. In this study, a chitosan/polyacrylamide double-network hydrogel was prepared by a simple two-step method. The swelling ratio of the double-network hydrogel increased with prolonged time, reaching 140. The compressive strength and compressive modulus of the hydrogel reached 53.6 and 0.34 MPa, respectively. Scanning electron microscopy revealed the hydrogel's crosslinked structure with many interconnecting pores. An MTT assay demonstrated that the number of viable cells in contact with the hydrogel extracts did not significantly change relative to the control surface. Thus, the hydrogel had good biocompatibility. Finally, the double-network hydrogel was used to compress the L4 nerve root of male sand rats to simulate lumbar disc herniation nerve root compression. The hydrogel remained in its original position after compression, and swelled with increasing time. Edema appeared around the nerve root and disappeared 3 weeks after operation. This chitosan/polyacrylamide double-network hydrogel has potential as a new implant material for animal models of lumbar nerve root compression. All animal experiments were approved by the Animal Ethics Committee of Neurosurgical Institute of Beijing, Capital Medical University, China(approval No. 201601006) on July 29, 2016.

Swelling-induced finite bending of functionally graded pH-responsive hydrogels:a semi-analytical method

Recently, pH-sensitive hydrogels have been utilized in the diverse applications including sensors, switches, and actuators. In order to have continuous stress and deformation ?elds, a new semi-analytical approach is developed to predict the swelling induced?nite bending for a functionally graded(FG) layer composed of a pH-sensitive hydrogel,in which the cross-link density is continuously distributed along the thickness direction under the plane strain condition. Without considering the intermediary virtual reference,the initial state is mapped into the deformed con?guration in a circular shape by utilizing a total deformation gradient tensor stemming from the inhomogeneous swelling of an FG layer in response to the variation of the pH value of the solvent. To enlighten the capability of the presented analytical method, the ?nite element method(FEM) is used to verify the accuracy of the analytical results in some case studies. The perfect agreement con-?rms the accuracy of the presented method. Due to the applicability of FG pH-sensitive hydrogels, some design factors such as the semi-angle, the bending curvature, the aspect ratio, and the distributions of deformation and stress ?elds are studied. Furthermore, the tangential free-stress axes are illustrated in deformed con?guration.

Interpenetrated Chitosan-Poly(Acrylic Acid-Co-Acrylamide) Hydrogels. Synthesis, Characterization and Sustained Protein Release Studies

Interpenetrated polymer networks of chitosan (CHI), polyacrylic acid (PAA) and polyacrylamide (PAM) were prepared by free radical polymerization. These hydrogels were either washed with double distilled water (CHI/PAA/PAM) A or hydrolyzed with 1M sodium hydroxide (NaOH), (CHI/PAA/PAM) S. Both types of hydrogels were characterized by infrared spectroscopy, microstructural techniques and compressive mechanical testing. Finally, hydrogels were loaded with bovine serum albumin (BSA) and release followed at different pHs. Infrared spectra analysis showed correspondence between hydrogels and monomer feed compositions. Hydrolyzed hydrogels, had increased water content and pH swelling dependence. Compression modulus of swelled hydrolyzed hydrogels decreased with increasing equilibrium water content. Higher BSA loadings were achieved on hydrolyzed hydrogels due to their high water content and porosity. Protein release from hydrogels was low (≤ 20% after 10 hours) at pH 1.2, but sustained release was observed at pH 6.8 and 7.4. The integrity of the protein released at 6.8 and 7.4 by hydrolyzed hydrogels was unaffected. The hydrogles showed no cytotoxic effects on human skin dermal fibroblasts as determined by MTT assay except for two compositions of (CHI/PAA/PAM) A samples, which after seven days presented a viability lower than 80% respect to the control.