Control of the injectability of calcium carbonate-calcium phosphate mixed cements for bone reconstruction

The purpose of this study was to improve injectability and cohesiveness of original calcium carbonate-calcium phosphate mixed (CaCO3-CaP) self-setting paste for bone filling and repair. With this aim in view dry co-grinding was implemented on the solid phase (vaterite and dicalcium phosphate dihydrate) of this cement. A protocol designed to quantify paste injectability has been established and pointed out the synergistic positive effects of solid phase co-grinding treatment on injectability, cohesiveness and setting time of the paste. The improvement of these properties are related to close and homogeneous association of reactive powders and to the decrease of specific surface area favoring the powders hydration process enhancing setting reaction rate. In addition, the particle size decrease and morphology modification improved flowability of the paste which results in a low and constant (320 g) force level to extrude the paste

Rheological properties of calcium carbonate self-setting injectable paste

With the development of minimally invasive surgical techniques, there is growing interest in the research and development of injectable biomaterials with controlled rheological properties. In this context, the rheological properties and injectability characteristics of an original CaCO3 self-setting paste have been investigated. Two complementary rheometrical procedures have been established using a controlled stress rheometer to follow the structure build-up at rest or during gentle mixing and/or handling on the one hand, and the likely shear-induced breakdown of this structure at 25 or 35 C on the other. The data obtained clearly show the influence of temperature on the development of a cement microstructure during setting, in all cases leading to a microporous cement made of an entangled network of aragonite-CaCO3 needle-like crystals. Linear viscoelastic measurements arriving from an oscillatory shear at low deformation showed a progressive increase in the viscous modulus (G0 0) during paste setting, which is enhanced by an increase in temperature. In addition, steady shear measurements revealed the shear-thinning behaviour of this self-setting paste over an extended period after paste preparation and its ability to re-build through progressive paste setting at rest. The shear-thinning behaviour of this self-setting system was confirmed using the injectability system and a procedure we designed. The force needed to extrude a homogeneous and continuous column of paste decreases strongly upon injection and reaches a weight level to apply on the syringe piston around 2.5 kg, revealing the ease of injection of this CaCO3 self-setting paste

Optimization of spray-dried hyaluronic acid microspheres to formulate drug-loaded bone substitute materials

Wepresent here our first results concerning the evaluation of hyaluronic acid (HA) as a candidate to formulate an organic–mineral cement with sustained release properties. Incorporating drug-loaded microspheres in mineral bone cements is an alternative strategy to improve their ability as drug delivery materials. To synthesize microspheres according to a reproducible process and control at the same time their morphology and their encapsulation efficiency is one of the main challenges of the conception of such drug-loaded bone substitute. In this context, we investigated the potentialities of two HA, differing by theirmolecular weight, to form microspheres by a spray-drying technique. Erythrosin B (EB) was encapsulated as a model drug and spray-drying process conditionswere optimized. To performthis, the rheological behavior and viscosity of HA solutions have been related to their spray-drying ability, and then to the resulting microparticles morphological properties and size distribution. Reproducible microspheres, answering to the requirements in terms of size and encapsulation efficiency, have been obtained from both HA. However the HA exhibiting the lowest molecular weight, HA600, led to smaller microparticles, with a higher polydispersity index. Their swelling ability, related to their stability upon rehydration, also appeared reduced. In this context, HA850, with the highest molecular weight, was selected and the possibility to modulate drug release by HA850 microspheres incorporation into a mineral cement was explored. EB release kinetics from HA microspheres, HA microspheres loaded cement and reference cement were followed at 37 °C, in Tris buffer at pH 7.4, using European Pharmacopoeia flow-through cells. Results showed that HA microspheres incorporation into a mineral cement permitted to modify the cement drug release profile and led to a sustained release

High-level transgene expression by homologous recombination-mediated gene transfer

Gene transfer and expression in eukaryotes is often limited by a number of stably maintained gene copies and by epigenetic silencing effects. Silencing may be limited by the use of epigenetic regulatory sequences such as matrix attachment regions (MAR). Here, we show that successive transfections of MAR-containing vectors allow a synergistic increase of transgene expression. This finding is partly explained by an increased entry into the cell nuclei and genomic integration of the DNA, an effect that requires both the MAR element and iterative transfections. Fluorescence in situ hybridization analysis often showed single integration events, indicating that DNAs introduced in successive transfections could recombine. High expression was also linked to the cell division cycle, so that nuclear transport of the DNA occurs when homologous recombination is most active. Use of cells deficient in either non-homologous end-joining or homologous recombination suggested that efficient integration and expression may require homologous recombination-based genomic integration of MAR-containing plasmids and the lack of epigenetic silencing events associated with tandem gene copies. We conclude that MAR elements may promote homologous recombination, and that cells and vectors can be engineered to take advantage of this property to mediate highly efficient gene transfer and expressio

Development of an injectable composite for bone regeneration

With the development of minimally invasive surgical techniques, there is a growing interest in the research and development of injectable biomaterials especially for orthopedic applications. In a view to enhance the overall surgery benefits for the patient, the BIOSINJECT project aims at preparing a new generation of mineral-organic composites for bone regeneration exhibiting bioactivity, therapeutic activity and easiness of use to broaden the application domains of the actual bone mineral cements and propose an alternative strategy with regard to their poor resorbability, injectability difficulties and risk of infection. First, a physical-chemical study demonstrated the feasibility of self-setting injectable composites associating calcium carbonate-calcium phosphate cement and polysaccharides (tailor-made or commercial polymer) in the presence or not of an antibacterial agent within the composite formulation. Then, bone cell response and antimicrobial activity of the composite have been evaluated in vitro. Finally, in order to evaluate resorption rate and bone tissue response an animal study has been performed and the histological analysis is still in progress. These multidisciplinary and complementary studies led to promising results in a view of the industrial development of such composite for dental and orthopaedic applications

Co-grinding significance for calcium carbonate-calcium phosphate mixed cement. Part II: effect on cement properties

In the present study, we aim to evaluate the contribution of the co-grinding process in controlling calcium carbonate-dicalcium phosphate dihydrate cement properties. We set a method designed to evaluate phase separation, usually occurring during paste extrusion, which is quantitative, reliable, and discriminating and points out the determining role of cogrinding to limit filter-pressing. We show that solid phase co-grinding leads to synergistic positive effects on cement injectability, mechanical properties, and radio-opacity. It allows maintaining a low (<0.4 kg) and constant load during the extrusion of paste, and the paste’s composition remains constant and close to that of the initial paste. Analogous behavior was observed when adding a third component into the solid phase, especially SrCO3 as a contrasting agent. Moreover, the cement’s mechanical properties can be enhanced by lowering the L/S ratio because of the lower plastic limit. Finally, unloaded or Sr-loaded cements show uniform and increased optical density because of the enhanced homogeneity of dry component distribution. Interestingly, this study reveals that cogrinding improves and controls essential cement properties and involves processing parameters that could be easily scaled up. This constitutes a decisive advantage for the development of calcium carbonate-calcium phosphate mixed cements and, more generally, of injectable multicomponent bone cements that meet a surgeon’s requirements

Dynamic vulnerability revealed in the collapse of an Arctic tidewater glacier

Abstract Glacier flow instabilities can rapidly increase sea level through enhanced ice discharge. Surge-type glacier accelerations often occur with a decadal to centennial cyclicity suggesting internal mechanisms responsible. Recently, many surging tidewater glaciers around the Arctic Barents Sea region question whether external forces such as climate can trigger dynamic instabilities. Here, we identify a mechanism in which climate change can instigate surges of Arctic tidewater glaciers. Using satellite and seismic remote sensing observations combined with three-dimensional thermo-mechanical modeling of the January 2009 collapse of the Nathorst Glacier System (NGS) in Svalbard, we show that an underlying condition for instability was basal freezing and associated friction increase under the glacier tongue. In contrast, continued basal sliding further upstream increased driving stresses until eventual and sudden till failure under the tongue. The instability propagated rapidly up-glacier, mobilizing the entire 450 km2 glacier basin over a few days as the till entered an unstable friction regime. Enhanced mass loss during and after the collapse (5–7 fold compared to pre-collapse mass losses) combined with regionally rising equilibrium line altitudes strongly limit mass replenishment of the glacier, suggesting irreversible consequences. Climate plays a paradoxical role as cold glacier thinning and retreat promote basal freezing which increases friction at the tongue by stabilizing an efficient basal drainage system. However, with some of the most intense atmospheric warming on Earth occurring in the Arctic, increased melt water can reduce till strength under tidewater glacier tongues to orchestrate a temporal clustering of surges at decadal timescales, such as those observed in Svalbard at the end of the Little Ice Age. Consequently, basal terminus freezing promotes a dynamic vulnerability to climate change that may be present in many Arctic tidewater glaciers

Neurocognitive function in patients with atrial fibrillation undergoing pulmonary vein isolation

BackgroundAtrial fibrillation (AF) is associated with cognitive dysfunction. However, neurocognitive function in AF patients undergoing pulmonary vein isolation (PVI) has not been well studied. The aim of this analysis is to compare neurocognitive function in patients who did or did not undergo PVI.Materials and methodsWe used data from the Swiss Atrial Fibrillation Cohort study (Swiss-AF), a prospective, observational, multicenter study in Switzerland. Patients with documented AF were enrolled and data of 1,576 patients without history of PVI and with complete information on PVI status and neurocognitive function were used. Information on PVI was collected at baseline and during 1 year of follow-up. Neurocognitive testing was performed at baseline and after 1 year of follow-up, using the Montreal Cognitive Assessment (MoCA), trail making test (TMT) A and B, digit symbol substitution test (DSST) and semantic fluency test (SFT). To investigate the association of PVI with neurocognitive function, we use propensity score matching (1:3) and inverse probability of treatment weighting (IPTW).ResultsThe mean age of this population was 74 ± 8 years, 27.1% were women. Overall, 88 (5.5%) patients underwent PVI during 1 year of follow-up. Using ITPW (n = 1576), PVI was weakly associated with the MoCA score after adjusting for time since PVI, baseline MoCA score and other covariates (β (95%CI) 1.19 (0.05; 2.32), p = 0.04). In the propensity matched comparison (n = 352), there was no significant association between PVI and the MoCA score (β (95%CI) 1.04 (−0.19; 2.28), p = 0.1). There were no significant associations between PVI and cognitive function when using the TMT A and B, DSST or SFT independent of the method used.ConclusionIn this population of AF patients, there was no consistent evidence of an association between PVI and neurocognitive function.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT02105844]

Neurocognitive function in patients with atrial fibrillation undergoing pulmonary vein isolation.

BACKGROUND Atrial fibrillation (AF) is associated with cognitive dysfunction. However, neurocognitive function in AF patients undergoing pulmonary vein isolation (PVI) has not been well studied. The aim of this analysis is to compare neurocognitive function in patients who did or did not undergo PVI. MATERIALS AND METHODS We used data from the Swiss Atrial Fibrillation Cohort study (Swiss-AF), a prospective, observational, multicenter study in Switzerland. Patients with documented AF were enrolled and data of 1,576 patients without history of PVI and with complete information on PVI status and neurocognitive function were used. Information on PVI was collected at baseline and during 1 year of follow-up. Neurocognitive testing was performed at baseline and after 1 year of follow-up, using the Montreal Cognitive Assessment (MoCA), trail making test (TMT) A and B, digit symbol substitution test (DSST) and semantic fluency test (SFT). To investigate the association of PVI with neurocognitive function, we use propensity score matching (1:3) and inverse probability of treatment weighting (IPTW). RESULTS The mean age of this population was 74 ± 8 years, 27.1% were women. Overall, 88 (5.5%) patients underwent PVI during 1 year of follow-up. Using ITPW (n = 1576), PVI was weakly associated with the MoCA score after adjusting for time since PVI, baseline MoCA score and other covariates (β (95%CI) 1.19 (0.05; 2.32), p = 0.04). In the propensity matched comparison (n = 352), there was no significant association between PVI and the MoCA score (β (95%CI) 1.04 (-0.19; 2.28), p = 0.1). There were no significant associations between PVI and cognitive function when using the TMT A and B, DSST or SFT independent of the method used. CONCLUSION In this population of AF patients, there was no consistent evidence of an association between PVI and neurocognitive function. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/], identifier [NCT02105844]

High-level transgene expression by homologous recombination-mediated gene transfer

Gene transfer and expression in eukaryotes is often limited by a number of stably maintained gene copies and by epigenetic silencing effects. Silencing may be limited by the use of epigenetic regulatory sequences such as matrix attachment regions (MAR). Here, we show that successive transfections of MAR-containing vectors allow a synergistic increase of transgene expression. This finding is partly explained by an increased entry into the cell nuclei and genomic integration of the DNA, an effect that requires both the MAR element and iterative transfections. Fluorescence in situ hybridization analysis often showed single integration events, indicating that DNAs introduced in successive transfections could recombine. High expression was also linked to the cell division cycle, so that nuclear transport of the DNA occurs when homologous recombination is most active. Use of cells deficient in either non-homologous end-joining or homologous recombination suggested that efficient integration and expression may require homologous recombination-based genomic integration of MAR-containing plasmids and the lack of epigenetic silencing events associated with tandem gene copies. We conclude that MAR elements may promote homologous recombination, and that cells and vectors can be engineered to take advantage of this property to mediate highly efficient gene transfer and expression