Development and characterization of an injectable dextrin-based hydrogel for bone regeneration

Bone is a dynamic, highly vascularized tissue that remodels itself continuously over an individual ́s lifetime. It plays several important roles in maintaining homeostasis of the body systems [ 1 , 2 ] . However, this regenerative capac ity is limited and, as in the case of large bone defects, where the template for an orchestrated regeneration is absent, surgical proce dures are needed [ 2 ] . In this respect , bone tissue engineering is a very challe nging and promising field given the need to mimic bone mechanical and biological functions and also due to the failure of current orthoped ic implants. The general concept consists in the development of three - dimensional scaffolds, from biocompatible materials (natu ral or synthetic), which confer temporary support for the regeneration of bone tissue, while the scaffold itself will be resorbed and replaced by new ly formed tissue [ 2 , 3 ] . Hydrogels are cross - linked networks made of natural or synthetic polymers, which are able to support high water contents [ 4 ] . These materials are usua lly biocompatible, have the ability to mimic physiological conditions, promote an environment that can protect cells or unstable drugs, their physical characteristics can be controlled to some extent and some can be injected in vivo . These features make th em attractive materials in the biomedical field for cell encapsulation, drug or gene delivery or to act as an interfa ce between tissue and materials [ 4 - 7 ] . Natural polymers are advantageous for this kind of applications since they are cheap raw materials, bear a great biocompatibility and are usually biodegradable [ 8 ] . Dextrin is low molecular weight carbohydrate, generally regarded as safe (GRAS), obtained from partial hydrolysis of starch or glycogen [ 9 ] . It is a glucose polymer linked by α - 1,4 glycosidic linkages with some degree of branching due to the presence of α - 1,6 bonds [ 10 ] . I t is biocompatible and non - immunogenic, degradable by α - amylases and can undergo renal clearance avoiding tissue accumulation [ 11 , 12 ] . This work describes the preparation and characterization of an injectable dextrin - bas ed hydrogel (oDex) able to incorporate nanoparticles , cells, biomolecules or Bonelike ® granules [ 13 ] . Bonelike ® is a Biosckin - molecular and cell therapies S.A. proprietary synthetic bone graft, and the outcome of the project will result in a novel injectable presentation of this product. The hydrogel was produced by dextrin oxidation with sodium periodate followed by cross - linking with a dihydrazide [ 14 ] . In vitro characterization of oDex hydrogel has shown acceptable m echanical properties, overall good biocompatibility and the ability to be combined with other materials such as a nanogel and urinary bladder matrix, without affecting its structure. The cytotoxicity of the free dihydrazide was evaluated and only a mild in hibitory effect on cell proliferation was observed for the concentration used in the hydrogel crosslinking. The biocompatibilit y of oDex hydrogels was confirmed through the encapsulation of cells, which were able to endure the gelation process. Subcutaneou s implants were performed in Sasco Sprague Dawley rats in order to evaluate the inflammatory response and systemic effects of oDex hydrogels and their combination with Bonelike ® and human mesenchymal stem cells isolated from umbilical cord’s Wharton jelly. After 3 and 15 days post - implantation, a quantitative evaluation of both responses was performed according to ISO 10993 by a scoring system leading to a classification of the implanted material as s light irritant even when associated to Bonelike ® or to the cellular system. The performance of oDex hydrogel combined with Bonelike granules and/or UBM in bone defects was investigated in New Zealand rabbits. Bone defects in several anatomical locations (t ibiae and cranium) of non - critical and critical size were filled with those materials. Histological analysis showed that oDex does not constitute a barrier for cellular colonization and proliferation since the defects that were filled with these materials presented a higher degree of regeneration and a higher amount of collagen fibers with higher organization degrees, when compared with the empty defects. Even though oDex hydrogels purpose is to act as an injectable carrier for osteoconductive materials, li ke Bonelike ® granules, the hydrogel itself seems to assists the regenerative pro cess when compared with the empty defects. This is due to the 3D supp ort conferred by hydrogels that facilitates cell migration to the defect site. Moreover, the presence of UB M strongly stimulates the bone regeneration, for levels comparable with the Bonelike ® conditions, since an increase in cellular colonization and organization in the defect site can be denoted. A sterilization protocol for oDex hydrogels by gamma and beta r adiation was investigated through irradiation of oxidized dextrin solutions. Despite b oth kinds of radiation induced slight differences in the storage modulus of the hydrogels, indicating the occurrence of chain scission/cross - linking effects on the dextri n cha in, all materials were gelable after the irradiation treatments . These effects seem to not be dose or temperature dependent and the irradiation process in liquid or solid state also does not induce major differences in the rheology of the final hydrog els. Due to its known advantages, gamma radiation seems to be a suitable sterilization method for oxidized dextrin solutions. The stability of gamma irradiated dextrin solutions was evaluated up to 8 months. Despite the increase of storage modulus of the h ydrogels over the time, this effect does not constitute a disadvantage since it improves elastic behavior of the hydrogels. oDex hydrogels provides a system that can carry and stabilize cells, nanogels, Bonelike ® granules and other biomolecules. It is a pr omising biomaterial due to its biocompatibility, and potential to promote an adequate environment for bone regeneration. Its injectability allows a minimal invasive surgical procedure with decreased patient morbidity, lower risk of infection and reduced sc ar formation. This work has been developed in the scope of an European project that allowed collaborations with research groups, which have complementary expertise. The tight collaboration between University of Minho and Bioskin S.A. company, envisioning t echnology transfer and product valorization, has resulted in a published international patent of the product ( WO2011070529A2 ) [ 15 ] . Currently, a new set of pre - clinical trials in sheep model s are being planned as well as the submission of a request for the authorization for the clinical trialsGrant SFRH/BD/64571/2009 from Fundação para a Ciência e Tecnologia (FCT), Portugal. We thank FCT funding through EuroNanoMed ENMED/0002/2

ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe

Background Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. Material and Methods A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. Results The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. Conclusion Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe

Crosslinking of poly(vinylene fluoride) separators by gamma-irradiation for electrochemical high power charge applications

Macroporous poly(vinylene fluoride) (PVdF) separators were prepared by phase inversion method and introduced to a gamma (γ) radiation with and without cross-linking agents. Triallyl isocyanurate (TAIC) and a macromonomer of ethylene oxide- propylene oxide (MEP) were used as a cross-linking agent. The resulting membranes were characterized in terms of thermal and mechanical properties. Ionic conductivities were determined in a molar solution of tetraethylammonium tetrafluoroborate (TEABF4) in acetonitrile (AN) and propylene carbonate (PC). Excellent mechanical properties (250 MPa at 25 °C) and conductivities (14 mS cm−1) were obtained for the cross-linked separator prepared with TAIC