Fibrin Glue Research Articles

Conjunctival autograft with fibrin glue in primary pterygium Demographic profile, visual, refractive and surgical outcome

: To compare the pre and post-operative visual, refractive and surgical outcome. It was a prospective interventional study of 56 primary pterygium patients with 12 months follow up. All patients underwent surgery with pterygium excision and conjunctival autograft fixation with fibrin glue without any fixating suture and adjuvant. Pre and post- operative visual acuity, spherical equivalent was compared and surgical outcome were evaluated. All patients were followed up to 12 months. The mean age was 42.43 ±13.38 years with male predominance. Seventy five percent (n=42) patients with normal vision (6/5 to 6/12, according to WHO) became 96% (n=54), 4 week post-operatively. Preoperatively, 42.8% (n=24) patients had spherical equivalent up to 1 D followed by 25% (n=14) Plano, 17.9% (n=10) up to 2 D, 5.4% (n=3) up to 3 D, 3.6% (n=2) had more than 3D which post operatively became 57.1% (n=32) up to 1D, 26.8% (n=15) Plano, 12.5% (n=7) up to 2D and there was no patients more than 2D with pre and post-operative comparison, p value of 0.000. There were no recurrence in 12 months follow up. Fibrin glue is very much effective in reducing recurrence rate and minimizes the complication with a very good visual outcome within 4 week postoperatively if surgery done carefully.

The healing capacity and osteogenesis pattern of demineralized dentin matrix (DDM)-fibrin glue (FG) compound

Demineralized dentin matrix (DDM) is an osteoconductive and osteoinductive material that has been successfully used in sinus floor augmentation and alveolar ridge augmentation in clinical applications. It releases bone morphogenetic proteins (BMPs) and other growth factors, making DDM a suitable grafting material. However, the granular particle of DDM makes it difficult to anchor into the bone defect area. The aim of this study was to investigate the biological effects and osteoinductivity of the combination of DDM and Fibrin Glue (FG) at an optimal ratio on bone healing from a critical bone defect in an animal model. The mouse osteoblastic cell line (MC3T3-E1) was co-cultured with various ratios of DDM and FG to examine their effects on osteoblast proliferation and differentiation, as indicated by alkaline phosphatase (ALP) activity, osteocalcin (OC) production and mineralized nodules formation. The optimal ratio was then chosen for further study with a rabbit calvarial defective model, in which they were implanted with DDM or DDM-FG1 (1 g: 0.1 ml) and DDM-FG2 (1 g: 0.5 ml) compounds, or left blank for 2, 4, 8 and 12 weeks to investigate soft tissue and new bone regeneration. Micro-CT and histology analysis were used to evaluate the total grafting properties according to the different healing periods. The result from in vitro studies demonstrated that the ratio of 1:0.1 induced more ALP activity and mineralized nodules, while the ratio of 1: 0.5 (DDM-FG combined) induced more osteocalcin (OC) at specific time points. In the animal model, the 3D new bone volume in all DDM-FG treatment groups was significantly greater than that in the blank group at 2, 4, 8 and 12 weeks. Furthermore, the new bone volume was greater in DDM-FG2 when compared to the other groups during the early weeks of the healing period. In histological analysis, clusters of osteoblasts were formed adjacent to the DDM particles, and newly formed bone was observed in all groups, suggesting an osteoinductive property of DDM. Moreover, the greater new collagen synthesis observed at 4 weeks suggested that early bone healing was induced in the DDM-FG2 group. This study demonstrated that at an optimal ratio, the DDM-FG compound enhances osteogenic activities and bone regeneration.

Intraoperative use of fibrin glue in blepharoplasty: a possible solution to reduce postoperative complication

The purpose of this study was to investigate the effects of intraoperative fibrin glue use on surgery for blepharoptosis. This retrospective study included patients with acquired blepharoptosis who underwent surgical correction and were followed for at least one month. Patients were classified into two groups depending on whether treated with antithrombotic agents or otherwise. All patients taking antithrombotic agents discontinued with the treatment one week prior to surgery in accordance with our clinical guidelines. Preoperative and postoperative marginal reflex distance 1(MRD1) and ecchymosis grade were evaluated and compared. The subjects were 56 patients (111 eyes) who discontinued antithrombotic agents before surgery and 59 patients (117 eyes) who had never taken antithrombotic agents. Fibrin glue was used in 13 patients (26 eyes, 23.4%) in the antithrombotic group, and 11 patients (21 eyes, 17.9%) in the non-antithrombotic group. The rate of severe ecchymosis was significantly lower in patients who used fibrin glue in the antithrombotic group at 1 week (11.5 vs 40.0%, p = 0.008). However, in non-antithrombotic group, there was no difference in the rate of severe ecchymosis according to the use of fibrin glue at 1 week (14.3 vs 30.2%, p = 0.181). In patients with a history of taking antithrombotic agents, the intraoperative use of fibrin glue is thought to be helpful as it could significantly reduce significant ecchymosis.

Evaluation and comparison of the efficacy of autologous fibrin glue with 4-0 silk sutures in periodontal flap closure and wound healing - A split mouth randomized controlled trial.

Fibrin glue has shown to be a pioneering remedy to overcome the inconvenience of suturing. Autologous products reduce the risk of contamination and immunological responses compared to commercial fibrin glue. Hence using autologous fibrin glue (AFG) as a tissue sealant in periodontal flap closure would be of added value for a predictable outcome. To evaluate and compare the efficacy of AFG with 4-0 silk sutures in periodontal flap closure and healing. Total of 17 patients diagnosed with generalized periodontitis in the age group of 18 to 60years with probing pocket depth of ≥ 6mm and clinical attachment level of ≥5mm in at least two quadrants were categorized into test group (AFG) and control group (4-0 silk sutures). Primary outcome measures [modified gingival index (MGI), early wound index (EHI) and interleukin 1 beta (IL-1ß) and secondary outcome measures (oral hygiene index, plaque index and visual analog scale (VAS) were recorded at baseline, 1, 2, 3 and 4 weeks. A statistically significant reduction of IL-1ß value (p =.005); MGI (p = .02); EHI (p = .004), VAS scores (p < .001) and a positive Spearman's correlation (rho = 0.15) was seen between EHI scores & IL-1ß levels in test group at 1week period in comparison to control group. AFG showed promising results as an alternative to sutures. The use of AFG significantly improved clinical parameters and reduced the levels of pro-inflammatory cytokines making it an effective adhesive with healing properties in the era of suture-less periodontal flap surgery.

Intraoperative control of air leak using a sutureless free pericardial fat pad covering method in lung cancer resection.

Here, we introduce a new method for intraoperative control of air leak using a free pericardial fat pad covering to lung damage with sutureless fixation. We covered the damaged lung tissue with a free pericardial fat pad with a polyglycol acid sheet and fibrin glue fixation. This method provides a good air leak controlling effect with the use of a free pericardial fat pad and relatively short operative time with sutureless fixation.

BONE MARROW-DERIVED STEM CELL TRANSPLANTATION FOR OSTEOCHONDRAL DEFECTS OF THE KNEE: A PROSPECTIVE CLINICAL STUDY

AbstractBackgroundAutologous chondrocyte implantation is a NICE approved intervention however it involves the morbidity of two operations, a prolonged rehabilitation and substantial healthcare costs. This study describes a novel, one-step, bone marrow (BM) derived mesenchymal stem cell (MSC) transplantation technique for treating knee osteochondral lesions and presents our prospective clinical study investigating the success of this technique in 206 lesions over a 5 year period.MethodologyThe surgical technique involves harvesting BM from patients’ anterior superior iliac spines, centrifugation to isolate MSCs and seeding into a type 1 collagen scaffold (SyngenitTM Biomatrix). Autologous fibrin glue is used to secure the scaffold into the defect. Inclusion criteria included patients aged 15 – 55 years old with symptomatic osteochondral lesions &gt;1cm2. Exclusion criteria included patients with ligament instability, uncorrected alignment, inflammatory arthropathy and a Body Mass Index &gt;35 kg/m2. Outcome measures included the Modified Cincinnati Knee Rating System (MCKRS), complications and reoperations.ResultsMean MCKR scores showed statistically significant improvements compared to pre-operative scores at 6 months 58.79 ± 3.5 and 1 year postoperatively 63.82 ± 3.93 with further improvements at 2 years and 5 years which did not reach statistical significance. Survival rates were 97.9%, 94% and 93.2% at 1, 2 and 5 years. Multiple regression analysis identified previous cartilage surgery, microfracture and age as factors affecting MCKRS scores (p &lt; 0.029, 0.001 and 0.030, respectively).ConclusionsOne-step BM derived stem cell transplantation demonstrates satisfactory outcomes over a 5 year period.

Evidence of Hematoma Prevention After Facelift.

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed which identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size less than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia over general anesthesia, and strict blood pressure control of at least <140mmHg were found to significantly reduce hematoma formation. The use of quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors (SSRIs), and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunctive measures have been shown to reduce post-operative hematoma formation in facelift procedures.

Evaluation of bone marrow-derived mesenchymal stem cells with eggshell membrane for full-thickness wound healing in a rabbit model.

Biomaterials capable of managing wounds should have essential features like providing a natural microenvironment for wound healing and as support material for stimulating tissue growth. Eggshell membrane (ESM) is a highly produced global waste due to increased egg consumption. The unique and fascinating properties of ESM allow their potential application in tissue regeneration. The wound healing capacity of bone marrow-derived mesenchymal stem cells (BM-MSCs), ESM, and their combination in rabbits with full-thickness skin defect (2 × 2cm2) was evaluated. Twenty-five clinically healthy New Zealand White rabbits were divided into five groups of five animals each, with group A receiving no treatment (control group), group B receiving only fibrin glue (FG), group C receiving FG and ESM as a dressing, group D receiving FG and BM-MSCs, and group E receiving a combination of FG, ESM, and BM-MSCs. Wound healing was assessed using clinical, macroscopical, photographic, histological, histochemical, hematological, and biochemical analysis. Macroscopic examination of wounds revealed that healing was exceptional in group E, followed by groups D and C, compared to the control group. Histopathological findings revealed improved quality and a faster rate of healing in group E compared to groups A and B. In addition, healing in group B treated with topical FG alone was nearly identical to that in control group A. However, groups C and D showed improved and faster recovery than control groups A and B. The macroscopic, photographic, histological, and histochemical evaluations revealed that the combined use of BM-MSCs, ESM, and FG had superior and faster healing than the other groups.

SYST-10 ENHANCING THE EFFICACY OF RADIATION THERAPY BY SURGICALLY TARGETED RADIATION-SENSITIZER LOADED FIBRIN GLUE

Abstract Radiation therapy (RT) forms an integral part of the treatment of brain tumors. Intrinsic, relative tumor radio-resistance, normal tissue tolerance and impact on neurocognitive function, all limit the efficacy of RT. Radiation sensitizers (RS) can potentially increase efficacy on tumor cells while maintaining normal tissue toxicity. Clinical trials, employing radiation sensitizers have been done, but so far, the results have been disappointing. An important factor that could account for the low efficacy of RS in clinical trials is the blood–brain barrier (BBB). The basis for this work was the development of a RS direct delivery system (DDS), that bypasses the BBB. This is implemented by the local implantation, into the tumor resection cavity, of RS loaded slow-release fibrin glue. Localized delivery significantly increases the concentration of RS reaching the remaining infiltrative tumor cells in the brain parenchyma, while avoiding systemic side effects. Additionally, the BBB would prevent retrograde flow of the RS into the circulatory system. and the RS is protected from degradation and clearance until locally released. FG has several characteristics that make it well suited for this form of agent delivery. It has been used clinically in surgery for decades, is FDA approved, its lack of toxicity has been clearly proven, it gels rapidly and spontaneously and is easily applied. Radiation protocols utilizing two sensitizers, 5FU and Motexafin-GD, have been optimized in vitro using 3D glioma spheroid models. The results obtained in vitro have been extended to an appropriate in vivo rat brain tumor model. The goal of this project is to improve the therapeutic index of radiation therapy and is therefore clearly aimed at eventually translating to new clinical treatment protocols.

Gelable and Adhesive Powder for Lethal Non‐Compressible Hemorrhage Control

AbstractHemostatic powders are widely used in clinical and emergency situations but often exhibit low wet adhesion, cytotoxicity concerns, and do not work well for lethal non‐compressible hemorrhage. Here a new kind of gelable and adhesive powder (GAP) is developed, which integrates chitosan microspheres (CM), tetra‐armed poly(ethylene glycol) amine (Tetra‐PEG‐NH2), and tetra‐armed poly(ethylene glycol) succinimidyl succinate (Tetra‐PEG‐SS). Upon application to the wound site, the macroporous CM can rapidly absorb the interfacial liquids, and meanwhile, the hydrated GAP turns into hydrogel (crosslinking between Tetra‐PEG‐SS and CM/Tetra‐PEG‐NH2) with stable and robust adhesion to the wet tissue though covalent bonding. The in vitro and in vivo results suggest that the GAP with optimized formulation exhibits strong tissue adhesive, high burst pressure, and enhanced blood clotting ability, as well as excellent biocompatibility and on‐demand removal properties. A significantly improved hemostatic efficacy is demonstrated in the rat liver, spleen, and femoral artery injury models compared to that of the CM, commercial fibrin glue, and Yunnan Baiyao (YB). The GAP can also halt the severe bleeding from pig visceral organs. Overall, the proposed GAP has many advantages including good biocompatibility, rapid and effective hemostasis, low cost, and ease of use, making it as a promising hemostat for lethal non‐compressible hemorrhage control.

A Ready-To-Use Purified Exosome Product for Volumetric Muscle Loss and Functional Recovery.

Large skeletal muscle defects due to trauma or following tumor extirpation can result in substantial functional impairment. Purified exosomes are now available clinically and have been used for wound healing. The objective of this study was to evaluate the regenerative capacity of commercially available exosomes on an animal model of volumetric muscle loss (VML) and potential translation to human muscle injury. An established VML rat model was used. In the in-vitro experiment, rat myoblasts were isolated and co-cultured with 5% purified exosome product (PEP) to validate uptake. Myoblast proliferation and migration was evaluated with increasing concentrations of PEP (2.5%, 5%, and 10%) in comparison to control media(F10) and myoblast growth media (MGM). In the in-vivo experiment, a lateral gastrocnemius-VML defect was made in the rat hindlimb. Animals were randomized into four experimental groups; defects were treated with either surgery alone, fibrin sealant, fibrin sealant and PEP, or platelet rich plasma (PRP). The groups were further randomized into four recovery timepoints (14, 28, 45, or 90 days). The isometric tetanic force (ITF), which was measured as a percentage of force compared to normal limb, was used for functional evaluation. Florescence microscopy confirmed that 5% PEP demonstrated cellular uptake around 8-12 hrs. Compared to control, myoblasts showed faster proliferation with PEP irrespective of concentration. PEP concentrations of 2.5 and 5% promoted myoblast migration faster compared to control (<0.05). At 90 days postop, both the PEP and fibrin sealant and PRP groups showed greater ITF compared to control and fibrin sealant alone (<0.05). At 45 days postop, PEP with fibrin sealant had greater cellularity compared to control (<0.05). At 90 days postop, both PEP with fibrin sealant and the PRP treated groups had greater cellularity compared to fibrin sealant and control (<0.05). PEP promoted myoblast proliferation and migration. When delivered to a wound with a fibrin sealant, PEP allowed for muscle regeneration producing greater functional recovery and more cellularity in vivo compared to untreated animals. PEP may promote muscle regeneration in cases of VML, further research is warranted to evaluate PEP for the treatment of clinical muscle defects.

Case Report: Central Corneal Perforation Management Secondary to Neurotropic Keratopathy in the Absence of Tectonic Corneal Graft, Barcelona CP

Purpose To present the emergency management of a patient with corneal perforation secondary to post-herpetic neurotrophic keratopathy (NK) with fibrin glue and amniotic membrane transplantation (AMT) in the absence of a tectonic corneal graft. Report of Case A 26-year-old male patient with a history of herpetic keratitis was admitted to our clinic with a finding of approximately 1 mm corneal central perforation in his right eye. The best corrected visual acuities of right and left eyes were 2.3 and 0 logMAR, respectively. Anterior segment examination revealed corneal edema, vascularization, shallow anterior chamber and central corneal perforation in the melting area. No pathology of the retina or vitreous was detected in B-scan ultrasonography. Anterior and posterior segment examination of left eye was normal. Conventional approaches including bandage contact lens failed to buffer the leak. Since human corneal donor tissue was not available, fibrin glue application from inside to outside along the perforation area combined with AMT was applied. Even after 2 weeks when the amnion was degraded, it was observed that the perforation area was stable without any additional intervention. Conclusion NK is one of the challenging reasons of corneal perforation. Although tectonic keratoplasty is the main treatment modality owing to transparency and high tissue resistance in the central corneal perforation repair, alternative treatment methods are necessary due to difficulty of access to donor cornea. Tissue adhesives and AMT are conservative methods to buffer leak with easier access. Present case clarifies the importance of alternative management modalities of corneal perforation in the absence of tectonic graft. Considering that only 1 donor cornea is available to 70 needed around the world, corneal perforation repair with fibrin glue combined with AMT seems wise.

Endoscopic closure of recurrent tracheoesophageal fistula using argon plasma coagulation: A case report

Recurrent tracheoesophageal fistula (RTEF) after surgical repair of esophageal atresia remains a serious complication. Open surgical repair for RTEF is associated with high levels of postoperative morbidity, mortality and repeat recurrence. Although endoscopic management has been expected to be an alternative to re-surgery, the optimal endoscopic management of RTEF remains to be determined. This report describes a successful experience of argon plasma coagulation (APC) for the closure of an intractable RTEF. A newborn male diagnosed as having esophageal atresia with tracheoesophageal fistula (TEF) underwent a primary surgical repair. At 17 months of age, an oral contrast study showed the recurrence of the TEF, and subsequently he underwent a second open surgery. However, a postoperative esophagogram revealed a second recurrence of the TEF. Then, endoscopic treatment options were considered and APC was employed to coagulate the fistula epithelium. At 31 months of age, APC followed by fibrin glue application was performed. By this procedure the RTEF could be occluded safely and successfully without any complications. APC is a simple, safe and effective procedure, and is therefore worth trying as a first attempt for the treatment of RTEF.

Fibrin sealant for the prevention of anastomotic leakage after esophagectomy for esophageal or esophagogastric junction cancer: interim report of a prospective, phase III, randomized controlled study

PurposeAnastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy.MethodsIn this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5ml FS applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively.ResultFrom February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively.ConclusionThe application of FS intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.Trial registrationThis trial was registered at ClinicalTrials.gov (NCT03847857) on February 19th, 2019.

Leukocyte- and platelet-rich fibrin in endoscopic endonasal skull base reconstruction: study protocol for a multicenter prospective, parallel-group, single-blinded randomized controlled non-inferiority trial

BackgroundRecent advances in endoscopic endonasal transsphenoidal approaches (EETA) for skull base lesions have resulted in a significant increase in extent and complexity of skull base defects, demanding more elaborate and novel reconstruction techniques to prevent cerebrospinal fluid (CSF) leakage and to improve healing. Currently, commercially available fibrin sealants are often used to reinforce the skull base reconstruction. However, problems have been reported regarding hypersensitivity reactions, efficacy, and costs. This trial aims to investigate autologous leukocyte- and platelet-rich fibrin (L-PRF) membranes as an alternative for commercially available fibrin glues in EETA-related skull base reconstruction reinforcement.Methods/designThis multicenter, prospective randomized controlled trial aims to demonstrate non-inferiority of L-PRF membranes compared to commercially available fibrin sealants in EETA cases (1) without intra-operative CSF-leak as dural or sellar floor closure reinforcement and (2) in EETA cases with intra-operative CSF-leak (or very large defects) in which a classic multilayer reconstruction has been made, as an additional sealing. The trial includes patients undergoing EETA in three different centers in Belgium. Patients are randomized in a 1:1 fashion comparing L-PRF with commercially available fibrin sealants. The primary endpoint is postoperative CSF leakage. Secondary endpoints are identification of risk factors for reconstruction failure, assessment of rhinological symptoms, and interference with postoperative imaging. Additionally, a cost-effectiveness analysis is performed.DiscussionWith this trial, we will evaluate the safety and efficacy of L-PRF compared to commercially available fibrin sealants.Trial registrationClinicalTrials.gov NCT03910374. Registered on 10 April 2019.

Pancreatic Fistulas: Current Evidence and Strategy-A Narrative Review.

Pancreatic fistulas are highly feared complications following surgery on or near the pancreas, abdominal trauma, or severe inflammation. These fistulas arise from leaks in the pancreatic ductal system, leading to various complications such as abscesses, delayed gastric emptying, and hemorrhage. Severe cases present with sepsis or organ failure, dramatically increasing mortality and morbidity. Risk factors include smoking, high BMI, male gender, age, and surgery-related factors like prolonged operation time and non-ligation of the main pancreatic duct. Therefore, treatment options and preventive measurements have become a hot topic in recent years. Studies have investigated the use of fibrin sealants, different closure methods, and less invasive surgical techniques. Treatment options consist of conservative measurements and the use of percutaneous drainage, prophylactic transpapillary stenting, and surgery in severe cases. As EUS has become widely available, transmural stenting started to influence the management of pancreatic fluid collections (PFCs). However, studies on its use for the management of pancreatic fistulas are lacking. Medical treatment options like somatostatin analogs and pasireotide have been investigated but yielded mixed results.

Effects of Adding Chitosan on Drug Entrapment Efficiency and Release Duration for Paclitaxel-Loaded Hydroxyapatite-Gelatin Composite Microspheres.

Hydroxyapatite-gelatin microspheres with cone-like pores were synthesized via the wet-chemical method using ammonium dihydrogen phosphate ((NH4)H2PO4) and calcium nitrate (Ca(NO3)2·4H2O) as a source of calcium and phosphate ions with the addition of gelatin, which proved to be more osteoconductive than commercial products, such as fibrin glue and Osteoset® Bone Graft Substitute. Following the method of the previous study for loading paclitaxel (PTX), a drug entrapment efficiency of around 58% was achieved, which is much lower than that of the doxorubicin (DOX)-loaded one. Since PTX is hydrophobic while DOX is hydrophilic, the order of chitosan processing and addition of the solvent were tuned in this study, finally leading to an increase in drug entrapment efficiency of 94%. Additionally, the release duration of PTX exceeded six months. The MTT assay indicated that the effect of drug release on the suppression of cancer cells reached more than 40% after one week, thereby showcasing PTX's capacity to carry out its medicinal functions without being affected by the loading procedures.

Late-presenting dural leak following spine fusion in the pediatric population.

The purpose is to describe how patients with a late-presenting dural leak (LPDL) after posterior spinal fusion (PSF) was diagnosed and treated at a single institution. Of the 1991 patients who underwent a PSF between 2010 and 2018, 6 patients were identified with a clinical course consistent with a potential LPDL. Six patients with median age 16.9years had onset of headache ranging 1-12weeks postoperatively (median 6.5weeks). All six patients presented with positional headache, and half (3/6) presented with emesis. 5/6 patients underwent contrast brain MRI, which demonstrated pachymeningeal enhancement. 4/5 patients with dural enhancement went on to have CT myelogram. Five patients had a CT myelogram, which identified a dural leak in all patients and localized the leak in four of five patients. All patients underwent an epidural blood patch, which resolved the pain in five patients. One patient without relief underwent revision surgery with removal of a medially placed screw and fibrin glue placement resolving symptoms. Postoperative dural leaks associated with PSF may present in a delayed fashion. The majority of leaks were not associated with screw malposition. In diagnosing patients with suspected LPDL, we suggest brain MRI with contrast as a first step. Most patients with pachymeningeal enhancement shown on contrast brain MRI had dural leaks that were identified through CT myelograms. For patients with a dural leak, if there is no disruption from screws, a blood patch appears to be an effective treatment. IV.

Chitosan/Hyaluronan and Alginate-Nanohydroxyapatite Biphasic Scaffold as a Promising Matrix for Osteoarthritis Disorders.

Regenerative medicine offers new techniques for osteoarthritis (OA) disorders, especially while considering simultaneous chondral and subchondral regenerations. Chitosan and hyaluronan were chemically bound as the chondral phase and the osteogenic layer was prepared with alginate and nano-hydroxyapatite (nHAP). These scaffolds were fixed by fibrin glue as a biphasic scaffold and then examined. Scanning electron microscopy (SEM) confirmed the porosity of 61.45±4.51 and 44.145±2.81 % for the subchondral and chondral layers, respectively. The composition analysis by energy dispersive X-ray (EDAX) indicated the various elements of both hydrogels. Also, their mechanical properties indicated that the highest modulus and resistance values corresponded to the biphasic hydrogel as 108.33±5.56 and 721.135±8.21 kPa, despite the same strain value as other groups. Their individual examinations demonstrated the proteoglycan synthesis of the chondral layer and also, the alkaline phosphatase (ALP) activity of the subchondral layer as 13.3±2.2 ng. After 21 days, the cells showed a mineralized surface and a polygonal phenotype, confirming their commitment to bone and cartilage tissues, respectively. Immunostaining of collagen I and II represented greater extracellular matrix (ECM) secretion in the biphasic composite group due to the paracrine effect of the two cell types on each other. For the first time, the ability of this biphasic scaffold to regenerate both tissue types was evaluated and the results showed satisfactory cellular commitment to bone and cartilage tissues. Thus, this scaffold can be considered a new strategy for the preparation of implants for OA.

Comparison of allogeneic mesenchymal stem cells therapeutic potentials in rabbits' cartilage defects: Μacroscopic and histological outcomes

Mesenchymal stem cells are safe and effective for treating joint injuries. However, the most suitable cell source remains controversial. This randomized controlled, double-blind study aimed to evaluate the potentials of rabbit allogeneic bone marrow- (BMSCs), adipose- (ASCs) and synovial membrane- (SDSCs) derived stem cells encapsulated in fibrin glue (FG) in vivo. The therapeutic properties of fibrin glue in critical-sized osteochondral defects (ODs) were also investigated. A 3 × 3 mm-sized OD was created in the femoral patellar groove on both knees of New Zealand rabbits, except from the left knees of the control group in which the OD was 2 × 3mm. The rabbits were randomly divided into four groups (right/left knee): 3 × 3 mm / 2 × 3 mm-sized OD control group, FG/FG with ASCs group, FG/FG with BMSCs group, FG/FG with SDSCs group. The International Cartilage Repair Society (ICRS) and the O'Driscoll scales were used to evaluate tissue characteristics after 12 weeks.FG promoted the production of reparative tissue with superior macroscopic features. Allogeneic MSCs combined with FG improved the macroscopic and histological scores more than the FG groups. The tissue in the SDSCs group was macroscopically and histologically better than the ASCs and BMSCs groups. The ICRS score differed among the SDSCs and the ASCs groups, while the empty critical-sized ODs were filled with inferior tissue compared to smaller ones.The preclinical feasibility of stem cells for OD regeneration in rabbits and the osteochondrogenic superiority of SDSCs was demonstrated. Additional tests and extended studies are required to reassure the long-term safety of these findings.