Ww Lu

A novel injectable bioactive bone cement for spinal surgery: A developmental and preclinical study

The injection of bone cement by minimally invasive techniques for the treatment of vertebral body fractures or for stabilization of an osteoporotic vertebral body is regarded as promising in spinal surgery. The purpose of this study was to develop a novel injectable bioactive bone cement to address such concerns. The cement was composed mainly of strontium-containing hydroxyapatite (Sr-HA) filler and Bisphenol A Diglycidylether Dimethacrylate (D-GMA) resin. The Sr-HA filler was prepared by precipitation and calcination, then analyzed with Fourier transform infrared (FTIR) spectra and X-ray diffraction (XRD) patterns. Samples of strontium-containing hydroxyapatite cement (SrHAC) were formed by a combination of powder filler and resin matrix, with the setting time and peak temperature recorded. Cell relative growth rate (RGR), Tetrazolium bromide (MTT), and haemolysis tests were used to detect initial in vitro biocompatibility of the new cement. In vitro spinal biomechanical testing and morphological observation after bone cement injection were performed on pig spines. Results indicate that the setting time and peak temperature of the cement was 15 min and 55 degrees C, respectively. Cytotoxicity of the cement was class 1 (no cytotoxicity) and haemolysis was 1% (no haemolysis). Stiffness after cement injection and fatigue loading were 112% and 95% of the intact bone, respectively, which is similar to that of natural bone. Radiopacity of SrHAC allowed easy radiographic imaging. The use of SrHAC cement is, thus, promising in spinal surgery.

Mechanical properties and in vitro response of strontium-containing hydroxyapatite/polyetheretherketone composites.

Strontium-containing hydroxyapatite/polyetheretherketone (Sr-HA/PEEK) composites were developed as alternative materials for load-bearing orthopaedic applications. The amount of strontium-containing hydroxyapatite (Sr-HA) incorporated into polyetheretherketone (PEEK) polymer matrix ranged from 15 to 30 vol% and the composites were successfully fabricated by compression molding technique. This study presents the mechanical properties and in vitro human osteoblast-like cell (MG-63) response of the composite material developed. The bending modulus and strength of Sr-HA/PEEK composites were tailored to mimic human cortical bone. PEEK reinforced with 25 and 30 vol% Sr-HA exhibited bending modulus of 9.6 and 10.6 GPa, respectively; alternatively, the bending strengths of the composites were 93.8 and 89.1 MPa, respectively. Based on the qualitative comparison of apatite formation in SBF and quantitative measurement of MG-63-mediated mineralization in vitro, the Sr-HA/PEEK composite was proven to outperform HA/PEEK in providing bioactivity. However, no difference was found in the trend of cell proliferation and alkaline phosphatase activity between different composites. Strontium, in the form of strontium-containing hydroxyapatite (Sr-HA), was confirmed to enhance bioactivity in the PEEK composites.

A Biomimetic Hierarchical Scaffold: Natural Growth of Nanotitanates on Three-Dimensional Microporous Ti-Based Metals

Nanophase materials are promising alternative implant materials in tissue engineering. Here we report for the first time the large-scale direct growth of nanostructured bioactive titanates on three-dimensional (3D) microporous Ti-based metal (NiTi and Ti) scaffolds via a facile low temperature hydrothermal treatment. The nanostructured titanates show characteristics of 1D nanobelts/nanowires on a nanoskeleton layer. Besides resembling cancelous bone structure on the micro/macroscale, the 1D nanostructured titanate on the exposed surface is similar to the lowest level of hierarchical organization of collagen and hydroxyapatite. The resulting surface displays superhydrophilicity and favors deposition of hydroxyapatite and accelerates cell attachment and proliferation. The remarkable simplicity of this process makes it widely accessible as an enabling technique for applications from engineering materials treatment including energy-absorption materials and pollution-treatment materials to biotechnology.

Solubility of strontium-substituted apatite by solid titration.

Solid titration was used to explore the solubility isotherms of partially (Srx-HAp, x=1, 5, 10, 40, 60 mol.%) and fully substituted strontium hydroxyapatite (Sr-HAp). Solubility increased with increasing strontium content. No phase other than strontium-substituted HAp, corresponding to the original titrant, was detected in the solid present at equilibrium; in particular, dicalcium hydrogen phosphate was not detected at low pH. The increase in solubility with strontium content is interpreted as a destabilization of the crystal structure by the larger strontium ion. Carbonated HAp was formed in simulated body fluid containing carbonate on seeding with Sr10-HAp, but the precipitate was strontium-substituted on seeding with Sr-HAp. Strontium-substituted HAp might be usable as a template for the growth of new bone, since nucleation appears to be facilitated.

Surface and corrosion characteristics of carbon plasma implanted and deposited nickel-titanium alloy

Nickel-titanium shape memory alloys (NiTi) are potentially useful in orthopedic implants on account of their super-elastic and shape memory properties. However, the materials are prone to surface corrosion and the most common problem is out-diffusion of harmful Ni ions from the substrate into body tissues and fluids. In order to improve the corrosion resistance and related surface properties, we used the technique of plasma immersion ion implantation and deposition to deposit an amorphous hydrogenated carbon coating onto NiTi and implant carbon into NiTi. Both the deposited amorphous carbon film and carbon plasma implanted samples exhibit much improved corrosion resistances and surface mechanical properties and possible mechanisms are suggested.

Modelling and simulation of the intervertebral movements of the lumbar spine using an inverse kinematic algorithm

An inverse kinematic model is presented that was employed to determine the optimum intervertebral joint configuration for a given forward-bending posture of the human trunk. The lumbar spine was modelled as an open-end, kinematic chain of five links that represented the five vertebrae (L1–L5). An optimisation equation with physiological constraints was employed to determine the intervertebral joint configuration. Intervertebral movements were measured from sagittal X-ray films of 22 subjects. The mean difference between the X-ray measurements of intervertebral rotations in the sagittal plane and the values predicted by the kinematic model was less than 1.6°. Pearson product-moment correlationR was used to measure the relationship between the measured and predicted values. TheR-values were found to be high, ranging from 0.83 to 0.97, for prediction of intervertebral rotation, but poor for intervertebral translation (R=0.08–0.67). It is concluded that the inverse kinematic model will be clinically useful for predicting intervertebral rotation when X-ray or invasive measurements are undesirable. It will also be useful to biomechanical modelling, which requires accurate kinematic information as model input data.

Nickel release behavior and surface characteristics of porous NiTi shape memory alloy modified by different chemical processes.

As a non-line-of-sight surface modification technique, chemical treatment is an effective method to treat porous NiTi with complex surface morphologies and large exposed areas due to its liquidity and low temperature. In the work described here, three different chemical processes are used to treat porous NiTi alloys. Our results show that H(2)O(2) treatment, NaOH treatment, and H(2)O(2) pre-treatment plus subsequent NaOH treatment can mitigate leaching of nickel from the alloy. The porous NiTi samples modified by the two latter processes favor deposition of a layer composed of Ca and P due to the formation of bioactive Na(2)TiO(3) on the surface. Among the three processes, H(2)O(2) pre-treatment plus subsequent NaOH modification is the most effective in suppressing nickel release. Small area X-ray photoelectron spectroscopy reveals that the surfaces treated by different chemical processes have different structures and compositions. The sample modified by the H(2)O(2) treatment is composed of rough TiO(2) on the outer surface and an oxide transition layer underneath whereas the sample treated by NaOH comprises a surface layer of titanium oxide and Na(2)TiO(3) together with a transition layer. The sample processed by the H(2)O(2) and NaOH treatment has a pure Na(2)TiO(3) layer on the surface and a transition layer underneath. These results help to elucidate the different nickel release behavior and bioactivity of porous NiTi alloys processed by different methods.

Comparison of time-frequency distribution techniques for analysis of spinal somatosensory evoked potential.

Spinal somatosensory evoked potential (SSEP) has been employed to monitor the integrity of the spinal cord during surgery. To detect both temporal and spectral changes in SSEP waveforms, an investigation of the application of timefrequency analysis (TFA) techniques was conducted. SSEP signals from 30 scoliosis patients were analysed using different techniques; short time Fourier transform (STFT), Wigner-Ville distribution (WVD), Choi-Williams distribution (CWD), coneshaped distribution (CSD) and adaptive spectrogram (ADS). The time-frequency distributions (TFD) computed using these methods were assessed and compared with each other. WVD, ADS, CSD and CWD showed better resolution than STFT. Comparing normalised peak widths, CSD showed the sharpest peak width (0.13±0.1) in the frequency dimension, and a mean peak width of 0.70±0.12 in the time dimension. Both WVD and CWD produced cross-term interference, distorting the TFA distribution, but this was not seen with CSD and ADS. CSD appeared to give a lower mean peak power bias (10.3%±6.2%) than ADS (41.8%±19.6%). Application of the CSD algorithm showed both good resolution and accurate spectrograms, and is therefore recommended as the most appropriate TFA technique for the analysis of SSEP signals.

Electrochemical Stability of Orthopedic Porous NiTi Shape Memory Alloys Treated by Different Surface Modification Techniques

The complex surface morphology and large exposed surface area induce electrochemical instability on porous NiTi shape memory alloys in human body fluids. Consequently, leaching of toxic nickel ions from the alloys impede wider applications of the materials in the biomedical fields, especially as bone implants. Electrochemical impedance spectroscopy (EIS) is a useful tool to evaluate the electrochemical stability of surface film in simulated body fluids (SBF) and to identify the most effective surface modification techniques for porous NiTi alloys. In the present work, EIS is employed to characterize porous NiTi alloys that have been modified by various processes in SBF at 37°C to evaluate the relationship between the surface film structure and electrochemical stability. Two different equivalent circuits involving a dual oxide film model with a porous outer layer and an inner barrier layer are proposed to model the experimental data acquired under open-circuit conditions for the control sample (dense NiTi) and porous NiTi alloys, respectively. The modeled results reveal that both chemical treatment and oxygen plasma immersion-ion implantation are effective surface modification techniques to form a protective film with higher electrochemical stability on the surface of porous NiTi alloys.

Isokinetic and isometric lifting capacity of Chinese in relation to the physical demand of job.

The aim of the study was to formulate normative data for the lifting capacities of a normal Chinese population, in order to establish a basic foundation for further studies and to investigate the relationship between individual attributes including age, gender, height, weight, job physical demand and each type of lifting capacity. Isokinetic and isometric lifting strength at low, waist and shoulder assessment levels were measured using the LIDO Workset II based on a sample of 93 normal Chinese adults (63 men and 30 women) between the ages of 21-51. The 50th percentile score for adult Chinese females lifting strength was 17.71% lower than the American female while the adult Chinese males lifting strength was 14.94% lower than the American male. Lifting forces were higher in the 20-40 year age group. The isometric work mode had considerable impact on the lifting capacities, with shoulder level having the highest lifting capacities. The gender and body weight had a significant positive correlation to lifting capacity while job physical demand had a moderate correlation. Age and body heights were weakly correlated to lifting capacity.