Objective To investigate the effect of rhBMP-2 combined with porous CPC on spine fusion in rabbits. Methods rhBMP-2 (1 mg) was loaded with 1 g CPC and 6.0 cm × 2.0 cm × 0.5 cm absorbable gelatin sponge (AGS), respectively, and thereafter frozen to prepare the biomaterial of rhBMP-2/CPC and rhBMP-2/AGS. Forty-five 24-week-old New Zealand rabbits (weight 2.5-3.5 kg) were randomly divided into 3 groups: group A (n=17), group B (n=11) and group C (n=17).With the exposure and removal of L5, 6 transverse process’s posterior bone cortex in all the rabbits, the corresponding cancellous bones were exposed and the posterior bilateral intertransverse bone grafting of L5, 6 were performed on the three groups, then the rhBMP-2/CPC, rhBMP-2/AGS and CPC was implanted into the rabbits of group A, B and C, respectively. Gross observation, histology assay and image examination were conducted 4, 8 and 24 weeks after operation. Results Decalcified hard tissue section demonstrated obvious callus connections in group A, small pieces of callus in group B, and fibrous connection and few cartilage in group C at 4 and 8 weeks after operation. By Kacena measurement standard, the score of group A, B and C at 4 weeks after operation was (7.30 ± 0.76), (3.68 ± 1.60) and (1.75 ± 0.54) points, respectively, and their score at 8 weeks after operation were (8.32 ± 1.11), (3.75 ± 1.23) and (1.47 ± 0.23) points, respectively, indicating there were significant differences between group A and group B as well as between group A and group C at different time points (P lt; 0.05). Undecalcified hard tissue section demonstrated that there was cancellous bone-l ike tissue regeneration in group A, and fiber connection around the implants and l ittle ossification in group C at 4 and 8 weeks after operation. By three dimensions reconstructed CT, group A, B and C scored (2.50 ± 0.57), (1.00 ± 0.00) and (1.00 ± 0.00) points respectively, indicating there was a significant difference between group C and groups A and B as well as between group A and group B (P lt; 0.05). Conclusion As a carrier of rhBMP-2, the CPC is capable of promoting spine bone fusion in rabbits and is a new type of artificial bone repair material.
Objective To investigate the cl inical appl ication of self-setting CPC loading rhBMP-2 for repair of bone defects and to evaluate the cl inical effect and safety. Methods From June 2006 to September 2007, 112 bone defects patients were treated by CPC loading rhBMP-2 (rhBMP-2/CPC group) or CPC (control group). The range of bone defect was from1 cm × 1 cm × 1 cm to 4 cm × 3 cm × 3 cm. In the control group, 63 patients included 31 males and 32 females, aging from 17 to 70 years with an average of 47.4 years. The bone defects were located as follows: calcaneus in 19 patients, tibial plateau in 20 patients, proximal humerus in 8 patients, distal radius in 9 patients and thoracolumbar vertebrae in 7 patients. In the rhBMP-2/CPC group, 49 patients included 31 males and 18 females, aging from 16 to 68 years with an average of 45.6 years. The bone defects were located as follows: calcaneus in 11 patients, tibial plateau in 16 patients, proximal humerus in 7 patients, distal radius in 2 patients, distal tibia in 2 patients and thoracolumbar vertebrae in 11 patients. All defects were repaired with rhBMP-2/CPC (2-5 g) and CPC (2-50 g) in the rhBMP-2/CPC group and the control group, respectively. Results A total of 108 patients got primary heal ing after operation. Incisions oozing l ight yellow fluids were found in 4 patients (control group in 1, rhBMP-2/CPC group in 3), and then healed through dressing changes and taking glucocorticoid. There were no allergic or toxic reaction, no rush or high fever, no fluctuation of hepatic and renal function, blood routine, CRP and urine routine. All patients were followed up for 12 to 24 months (mean 13.2 months). The X-ray examination showed that the implanted material was firmly bonded to the bone at the interface and the anatomic contour of the bone at the sites of defects was successfully restored, and no ablation occurred. All patients got bone union after 3 months of operation. The movement and function of flexion and extension of affected l imbs recovered to the normal level. Conclusion Repairing bone defects with rhBMP-2/CPC is safe and effective. Using rhBMP-2/CPC is a promising therapy to deal with bone defects.
Objective To summarize the effect of self-setting CPC on the repair of bone defect after tumor resection in children. Methods From December 1998 to December 2006, 32 patients with benign bone tumor were treated, and the bonedefect was repaired by CPC. Among them, there were 21 males and 11 females, aged 4-14 years old (9.8 on average). The course of disease was 3-18 months. There were 12 cases of non-ossifying fibroma, 8 of bone cyst, 7 of osteoid osteoma and 5 of fibrous dysplasia. The bone defect was located in femur in 15 cases, in tibia in 8 cases, in humerus in 6 cases and in other positions in 3 cases. The range of bone defect was 2.0 cm × 1.5 cm × 1.0 cm - 10.0 cm × 5.0 cm × 4.0 cm. CPC spongiosa granules of 3-23 g were filled in 26 cases, including 3 children with pathologic fracture and internal fixation with plate, and injectable CPC of 5-20 mL was filled in 6 bone cyst cases. Results Thirty-two patients obtained heal ing by first intertion. All the patients were followed up for 12-48 months (23.5 months on average). No allergic reaction, toxicity, rash or high fever was found after operation. There was no pain or pruritus at the incisions. The X-ray films showed that the implanted CPC began to fuse with the host bone 4-9 months (7 month on average) after operation. The internal fixation was removed within 6-12 months of operation. And CPC spongiosa granules were absolutely absorbed within 8-36 months of operation. However, injectable CPC could be found 4 years after operation. The children’s l imbs could do normal exercises. Finally, bone matrix grew well and no recurrence was found. Conclusion CPC in repairing bone defect after benign bone tumor in children is a safe, economical, convenient and non-toxic method.
Objective To access the possibil ity of CPC as a suitable scaffold for tissue engineering artificial rib by morphologic observation, adhesion experiments and cellar prol iferation experiments. Methods The 5 mm × 5 mm × 5 mm CPCs were prepared and the structure and components of CPC were compared with those of the normal human bone by micro-CT and scanning electron microscope. Bone marrow aspirates were harvested from the young pig and monuclear cells were separated. The first passage cells were collected and re-suspended in the culture media at a density of 6 × 105 cells/mL. There was 150 μL suspension which was incoluated on the CPC, and then cells were recollected and counted 4, 12 and 24 hours after inoculation. MTT was used to examine the growth condition of BMSCs on the surface of CPC. The scanning electron microscope was used to observe the CPC scaffold 7 days after inoculation, and comparison was made with CPC and the normal human bone. Results The adhesion rate of CPC was 28.00% ± 0.98%, 46.70% ± 1.14% and 48.50% ± 1.18%, respectively 4, 12 and 24 hours after compound culture. The prol iferation rate of CPC was 1.103 ± 0.214, 1.557 ± 0.322, 1.920 ± 0.178, 2.564 ± 0.226, 2.951 ± 0.415 and 3.831 ± 0.328, respectively 1, 2, 3, 4, 5 and 6 days after compound culture, with an obvious rising trend. The micro-CT demonstrated that the content of hydroxyapatite of porous phosphate calcium was (1 101.222 8 ± 0.618 4) mg/ ccm while that of the normal human bone was (1 072.552 3 ± 0.744 2) mg/ccm, and the porosity of porous phosphate calcium was 70.26% ± 0.45% while that of the normal human bone was 72.82% ± 0.51%, and there was no significant difference (P gt; 0.05). The experiment of cell prol iferation showed that the cell which was cultivated with porous phosphate calcium prol iferated rapidly. Through the inverted phase contrast microscope, it was found that the cells grew well and there was no dead cell, which indicated that the material had no toxicity. The rate of the cell adhesion to CPC was less than 50%. Conclusion The structure and components of CPC are similar to those of the normal human bone, and BMSCs grow well on the surface of it, so it is asuitable scaffold for tissue engineering artificial rib. However, the cell adhesion abil ity is to be further improved.
Objective To assess the efficacy of naloxone for cardio-pulmonary-cerebral resuscitation (CPCR). Methods Randomized controlled trials (RCTs) involving naloxone for CPCR were identified from MEDLINE (1966 – Jun.2006), EMbase (1974 - Jun.2006), PubMed, The Cochrane Library (Issue2,2006), CBM(1978 - Jun.2006) and CNKI (1994 - Jun.2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis. Results Ten RCTs were included. The quality of included RCTs was low. All the patients were in-patients or out-patients receiving CPCR due to cardial arrest at the age of 18-75 years. Meta-analysis indicated that the resuscitation rate in naloxone group was significantly higher than the placebo group (Plt;0.00001). And the recovery of the brain function in naloxone group was better than in the placebo group(Plt;0.00001) Conclusions Naloxone is effective for CPCR and it may ameliorate its prognosis. Because of the low quality of included trials and the small sample size, more RCTs are required to assess the efficacy of naloxone for CPCR.
Calcium phosphate cement (CPC) has been widely used as bone fillers because of its excellent bioactivity and biocompatibility. Meanwhile, CPC is also an attractive candidate for the incorporation of drug or microspheres, because the preparing procedure avoids sintering and heating release. This paper summarizes the clinical applications of microspheres incorporated in CPC from the aspects of sustained drug release, accelerated degradation, porous structure and improved mechanical properties. The paper is aimed to analyze the methods and principles of microspheres loaded CPC, and so as to lay a foundation for the further research of improving and manufacturing the CPC with ideal properties.