Search Results (1,084)

Bone loss represents a significant clinical burden that has driven the development of improved orthopedic graft substitutes. Although current grafting options, including autografts, allografts, and xenografts, have demonstrated considerable therapeutic potential, their widespread application is constrained by limitations such as donor scarcity, limited availability, and associated clinical risks. Consequently, biologically derived materials, including avian eggshells and marine bivalve shells, have emerged as promising alternative sources to produce bone precursor materials and next-generation bone graft substitutes. This review summarizes recent advances in avian eggshell- and marine shell-derived calcium carbonate (CaCO₃) materials for bone regeneration and examines their preclinical evaluation in diverse animal models, including critical-size defects in calvarial, femoral, radial and mandibular bone. Relevant studies published over the past ten years were systematically analyzed, focusing on natural calcium carbonate systems derived from avian eggshell and marine shells, including oyster, mussel, clam, scallop, cockle, and sea urchins. A structured literature search was conducted using PubMed, Scopus, and Google Scholar to identify studies published between 2015 and 2025 investigating eggshell- and aquatic-derived biomaterials for bone repair and regeneration. Eligible studies were screened, and data were comparatively analyzed with respect to biomaterial source, scaffold fabrication, physicochemical characteristics, mechanical performance, biocompatibility, osteogenic potential, and the use of preclinical animal studies. Eggshell-derived biomaterials currently show the strongest translational evidence, while aquatic shell-derived biomaterials remain promising but underexplored for bone regeneration. Furthermore, this review critically examines the scientific, manufacturing, and regulatory challenges that must be addressed before clinical implementation. Full article

Hollow fiber loose nanofiltration (HF-LNF) has attracted increasing attention as a pressure-driven membrane platform that combines loose nanofiltration (LNF) selectivity with the high packing density and self-supporting geometry of hollow fibers. This review critically evaluates recent advances in HF-LNF membranes, including controllable fabrication strategies, surface functionalization techniques, and practical engineering applications, with a discussion of life cycle assessment (LCA) for evaluating the environmental and economic sustainability of HF membrane systems. Phase inversion, interfacial polymerization (IP), coating, and grafting are compared in terms of structural controllability, process complexity, selective-layer stability, modification uniformity, reproducibility, and scale-up feasibility. Phase inversion is relatively compatible with continuous hollow-fiber spinning, but independent regulation of the support and selective layer remains difficult. IP provides greater control over selective-layer chemistry and effective pore size, whereas coating and grafting offer flexible surface functionalization but may be limited by additional transport resistance, layer durability, and non-uniform modification of curved surfaces. Direct HF-LNF application remains concentrated on dye/salt separation. Based on the evidence from HF-NF or flat LNF systems, the potential of HF-LNF in water softening, heavy metal removal and emerging pollutant control is analyzed. Critical challenges restricting industrial translation are discussed, including poor long-term antifouling capacity and difficulties in large-scale, low-cost manufacturing. On this basis, LCA is further introduced as a decision-support framework for identifying potential environmental hotspots in membrane manufacturing and operation, while the limited availability and comparability of HF-LNF-specific life-cycle data are explicitly recognized. Ultimately, it is proposed to focus on novel functional materials, eco-friendly preparation processes, and scaled membrane engineering, aiming to offer theoretical support for the rational design and real-world industrial deployment of next-generation HF-LNF membranes. Full article

Background: Complex wounds present significant reconstructive challenges owing to impaired healing, infections, and tissue loss. Skin grafting remains a widely used reconstructive technique; however, outcome data from the Gulf region are limited to a few studies. This study aimed to evaluate early graft outcomes and complications following skin graft reconstruction for complex wounds at a tertiary hospital. Methods: A retrospective, hospital-based study was conducted at Sultan Qaboos University Hospital (SQUH), including all patients who underwent split-thickness or full-thickness skin grafting between 2023 and 2025. Demographic, clinical, surgical, and wound-related data were collected. The main outcomes were graft take on postoperative days 5–7, time to complete re-epithelialization, and the occurrence of postoperative complications. Results: A total of 50 patients were included; 72% were males, with a median age of 45.5 years. Diabetes mellitus was present in 34% of patients. Trauma (28%) and infection/necrotizing causes (22%) were the most common etiologies of wounds. Complete graft take (>90%) was achieved in 90% of the patients, whereas 10% had partial graft take. The median time to complete re-epithelialization was 13 days. Complications were infrequent and minor, including postoperative infection (8%), hypertrophic scar formation (6%), and wound dehiscence (2%). No significant differences in healing time were observed between the diabetic and non-diabetic patients. Conclusions: In this descriptive institutional cohort, a combined protocol of wound-bed preparation, skin graft reconstruction, and postoperative NPWT-assisted stabilization was associated with favorable early graft take and fewer complications. These findings should be interpreted cautiously because of wound heterogeneity, unavailable wound size measurements, and limited subgroup sizes. Larger prospective studies are needed to evaluate the predictors of graft success. Full article

Background/Objectives: Dental implant and guided bone regeneration (GBR) procedures rely on successful bone healing and remodeling. Systemic metabolic factors, including vitamin D deficiency and elevated low-density lipoprotein cholesterol (LDL-C), may adversely affect osseointegration and bone regeneration. This study aimed to investigate the association between implant/GBR failure and serum vitamin D and LDL-C levels. Methods: A retrospective clinical study was conducted on 40 patients treated with dental implants and/or GBR procedures between 2023 and 2025 in the Eastern Province of Saudi Arabia. Twenty patients with failed outcomes and twenty patients with successful outcomes were included. Smokers, immunocompromised patients, individuals with a history of radiotherapy or chemotherapy, and patients with uncontrolled diabetes mellitus (HbA1c > 6.5%) were excluded. Failure was defined as progressive bone loss, loss of osseointegration, implant mobility, graft resorption, or persistent infection and was categorized as early or late failure. Serum vitamin D and LDL-C levels were obtained after treatment and analyzed using bivariate and exploratory multinomial logistic regression analyses. Results: Significant differences in serum vitamin D and LDL-C levels were observed among failure groups. Mean vitamin D levels were highest in the non-failure group (91.3 ± 47.9 nmol/L), followed by early failure (53.3 ± 33.7 nmol/L) and late failure (28.3 ± 11.3 nmol/L) (p = 0.001). Mean LDL-C levels increased progressively from the non-failure group (107.0 ± 26.8 mg/dL) to early failure (137.6 ± 47.3 mg/dL) and late failure groups (161.3 ± 57.0 mg/dL) (p = 0.003). Vitamin D status and LDL-C category were significantly associated with failure type (p = 0.001 and p = 0.012, respectively). Conclusions: Lower serum vitamin D levels and higher LDL-C levels were associated with implant and GBR failure, particularly in late failure cases. However, because serum vitamin D and LDL-C levels were measured after treatment outcomes and the study was limited by its retrospective design and relatively small sample size, these findings should be interpreted with caution and do not establish a causal relationship. Larger prospective studies are needed to determine whether preoperative assessment and optimization of vitamin D and lipid status may improve implant and regenerative treatment outcomes. Full article

In the contemporary era of minimally invasive surgery, injectable biomaterial scaffolds have demonstrated significant potential in bone tissue engineering (BTE). Completely injectable hydrogel substratum with microscale bone graft particulates delivered through a needle-shaped orifice shifts a new paradigm for surgical interventions in clinical settings. Despite growing interest in biopolymer-based BTE systems, clinically applicable delivery platforms and a mechanistic understanding of cell–material interactions remain limited. This study developed a dual-syringe auto-mix system capable of generating an in situ cross-linking hydrogel–mineral construct composed of gelatin–hydroxyphenyl propionic acid, hyaluronic acid–tyramine, horseradish peroxidase, hydrogen peroxide, and calcium phosphate particles of varying sizes. Material distribution, rheological and mechanical properties, and swelling were characterized. Goat bone marrow-derived mesenchymal stem cells served as the basis for examining how the composite affected cell viability, morphology, proliferation, contractility, osteogenic differentiation, mineralization, and chemotactic behavior. To determine whether these biological findings were supported mechanically, an ex vivo cone-beam computed tomography model was used to evaluate volumetric stability and resistance to deformation at the graft–host interface. Cross-linking established a stable internal microarchitecture while remaining compatible with cell viability and nutrient-dependent survival. Formation of the gelatin–hyaluronan (GH) network significantly increased the storage modulus relative to gelatin (G) alone, whereas subsequent calcium phosphate incorporation (GH-CP) preserved this mechanical competence while attenuating the volumetric expansion of GH. These physical characteristics were accompanied by more organized cell morphology, enhanced osteogenic differentiation, and mineral deposition throughout a larger portion of the matrix. Heterogeneous interpenetrating gap striation (HIGS) appeared in regions of cellular aggregation and matrix deposition, and a new conceptualization of the osteogenic phenomenon, termed cling osteogenesis, has been proposed. These outcomes support an intricate relationship between early mechanical stabilization, mechanotransduction, and osteogenesis in injectable hydrogel–mineral systems. Full article

Background and Clinical Significance: Implant rehabilitation of patients with acquired maxillofacial defects remains challenging, particularly following high-energy war-related trauma. Gunshot and mine blast injuries frequently result in extensive hard and soft tissue loss, often requiring complex reconstructive procedures. Although cortically anchored implants have been successfully used in patients with severe maxillary atrophy and selected traumatic defects, evidence supporting their use for the immediate rehabilitation of critical-size war-related maxillary defects remains limited. Cortically anchored single-piece implants used in conjunction with an immediate loading protocol may provide an alternative rehabilitation strategy for selected patients who decline, or are unsuitable for, conventional implants and bone-grafting procedures. Case Presentation: Two patients with critical-size maxillary defects (approximately 3 cm) resulting from gunshot and mine blast injuries are presented. Treatment consisted of extraction of non-restorable teeth, placement of cortically anchored single-piece implants, including tubero-pterygoid implants, followed by immediate loading with fixed hybrid metal–acrylic hybrid prostheses. Clinical and radiological evaluation was performed using panoramic radiography and cone-beam computed tomography. Conclusions: Successful implant-supported prosthetic rehabilitation was achieved in both patients. Cortically anchored implants engaging the basal bone of the maxilla provided stable support for immediately loaded fixed prostheses despite substantial hard and soft tissue loss. Functional and aesthetic outcomes were satisfactory. Immediate prosthetic rehabilitation was successfully completed in both patients. A 12-month clinical and radiographic follow-up was available for one patient and demonstrated stable implant function without biological or prosthetic complications. Long-term follow-up of the second patient was not available because of active military service. Cortically anchored implant-supported hybrid prostheses may represent a viable treatment option for selected patients with critical-size maxillary defects resulting from gunshot or mine blast injuries, enabling rapid restoration of oral function and facial aesthetics while avoiding extensive bone-grafting procedures. Full article

Transplanted neural precursor cells (NPCs) can support repair after spinal cord injury (SCI) but often face poor survival and limited differentiation within the hostile post-injury microenvironment. We tested whether subacute activation of Sonic hedgehog (Shh) signaling improves NPC engraftment and functional recovery over the duration of 6 weeks. Female Wistar rats underwent T9/T10 clip-contusion SCI and were assigned to vehicle, Shh-only, NPC-only, Shh + NPC, or sham groups (n = 8 per SCI arm, n = 5 sham, total n = 37). GFP + NPCs (4 × 10⁵) were grafted at 7 days post injury. Recombinant Shh or vehicle was delivered intrathecally via osmotic pumps for 7 days thereafter. Outcome measures included pathway activation (GLI1, SMO), NPC differentiation (NeuN, Olig2, Nestin, GFAP), astrogliosis (GFAP), CSPG deposition, immune cell infiltration (CD3, Iba1), apoptosis (cleaved Caspase-3), and locomotion (BBB, Gridwalk, CatWalk) over 6 weeks. Shh delivery increased GLI1/SMO expression and, when combined with NPCs, significantly elevated NPC-derived neurons and oligodendrocytes while preserving undifferentiated NPCs. Combined therapy reduced astrogliosis, CSPG deposition, T-cell and macrophage/microglial densities, cyst size and apoptotic cells compared with controls. These histological benefits were accompanied by improved locomotor scores in BBB, Gridwalk and selected CatWalk parameters. Our findings highlight the synergistic effects of Shh pathway activation and NPC transplantation in promoting neuroregeneration after SCI. The data support Shh as an adjunct to NPC transplantation for SCI repair. Full article

In humans, surgical repair is commonly performed for infective endocarditis (IE) associated with mitral valve destruction. However, extensive valve destruction may make repair impossible and require prosthetic valve replacement. In small-breed dogs, appropriately sized prosthetic valves are lacking, and complete surgical mitral valve reconstruction in dogs has not been reported. We encountered a Chihuahua that developed IE after mitral valve repair. During reoperation for progressive mitral regurgitation recurrence, the mitral leaflets were extensively destroyed and torn, and re-repair using native tissue was impossible; the entire valve was therefore reconstructed with fresh autologous pericardium. A graft was harvested and fashioned into a cylindrical valve based on a design previously described in a human study. Intraoperative saline testing and immediate postoperative echocardiography confirmed adequate opening and closure of the reconstructed pericardial valve, with only mild mitral regurgitation and no stenosis. The dog died on the second day after reoperative day of an uncontrolled infection caused by extended-spectrum beta-lactamase-producing Escherichia coli. This case demonstrates that an autologous pericardial valve can provide short-term mechanical function as a mitral valve in a small-breed dog and indicates that infection control is the principal determinant of outcome. Full article

Background: Allograft bone remains an attractive option for anterior cervical corpectomy and fusion (ACCF), but its use can be limited by variable graft geometry, insufficient endplate contact, and operator-dependent trimming. This study aimed to develop a titanium end-disc-assisted allograft construct with a standardized cutting and assembly system and to preliminarily evaluate its static mechanical integrity under axial compression, compression-shear, and torsional loading. Methods: The construct consisted of a controlled-length bone graft, two Ti6Al4V end-discs, and four countersunk fixation screws, forming a graft–disc construct with a maximum total height not exceeding 40 mm. The end-discs incorporated angled screw holes, bone-graft filling spaces, and enlarged contact surfaces. A modular preparation system was designed for graft clamping, length definition, guided cutting, alignment, pre-drilling, and screw fixation. Porcine rib specimens were used as an allograft substitute. Native bone and assembled constructs were tested under static compression, compression-shear, and torsion. Results: The system produced standardized constructs. Except for axial compressive stiffness, the assembled constructs showed numerically higher compressive yield force, shear stiffness, shear yield force, torsional stiffness, and yield torque than native bone; however, these findings were interpreted descriptively because of the limited sample size. Failure occurred mainly within the bone, with no obvious failure at the bone–titanium interface, titanium end-discs, or fixation screws. Conclusions: The proposed system enabled standardized graft preparation and construct assembly. Further fatigue, subsidence, and clinically relevant cervical spine model testing are required. Full article

Background: Volumetric evaluation is critical in living donor liver transplantation. Liver volume, depending on body weight and height, and radiological estimates have made important contributions, but some inconsistencies remain. We aimed to assess the estimated and radiological liver volumes with respect to actual graft weight and potential factors contributing to inaccuracy. Method: A total of 623 donors were evaluated in this retrospective study. The estimated liver volumes were calculated with the Vauthey formula. The laboratory and liver biopsy results were obtained. Three-dimensional liver tomography was used to assess liver volume. Actual graft weight was measured on the back table after perfusion. Graft types were recorded. A discrepancy of more than 10% is accepted as discordant. The possible reasons were evaluated. Results: The mean estimated liver volume and radiological liver volume were 1216 cm³ and 1290 cm³, respectively. The mean radiological right lobe volume and the actual right lobe graft weight were 815 and 846, respectively. Liver density, liver steatosis percentage, blood cholesterol levels, blood triglyceride levels, and blood total bilirubin levels are factors contributing to the disparity between the estimated and radiological volume differences. Vitamin B12 and albumin levels were associated with the discrepancy between radiological liver volume and actual graft weight. Underestimation was significant in the left lateral lobe. Conclusions: Three-dimensional volumetry is useful for size matching. Discrepancies of more than 10% are attributable to liver steatosis or splitting lines. Full article

We evaluated moderate cluster-zone warming in field-grown Monastrell grafted onto 110R and 140Ru over two seasons (2020–2021) in a semi-arid vineyard in south-eastern Spain. From pea-size to harvest, an open warming system increased cluster-zone air temperature by 1.15 °C on average. Warming increased cluster-zone mean and maximum temperatures, but berry temperature responses depended on year and rootstock because berry–air temperature differences and also time above thresholds changed. Berry weight increased in harvest in both years, and technological ripening advanced, with higher total soluble solids and maturity index, especially during ripening. Acid composition responded differently between rootstocks: under warming, 140Ru maintained higher malic acid and lower tartaric acid than 110R, resulting in a lower tartaric/malic ratio. Phenolic and colour responses were clearest at mid-ripening. Warming reduced must total phenolic index (TPI), skin-related phenolics, anthocyanins, and must colour more strongly in 140Ru, while 110R retained a more stable phenolic and colour profile. Exposure–response analyses showed that time in the 25–35 °C range and berry thermal time were more closely related to technological and phenolic variation than time above 35 °C. These results suggest that, under the warming conditions imposed in this study, 110R offered a better compromise than 140Ru between ripening advancement and the preservation of phenolic and colour-related traits. Full article

Grafting and foliar calcium application are common practices for improving vegetable crops, but their interactions in soil and soilless cultivation systems are not well understood. To address these knowledge gaps for sustainable greenhouse cucumber production, this study investigated the effects of calcium foliar application (control, 200 mg/L as nano-CaCO₃ or CaCl₂) and grafting (no grafting, grafting on Ganate rootstock or Routpower rootstock) on the growth and yield of greenhouse cucumber cv. Saba in soil and soilless systems. It should be noted that the two cultivation systems differed in several management factors (pot size, substrate, irrigation frequency, and fertilization method), and this study compares complete production packages rather than isolating individual factors. The experiment was conducted in a greenhouse using a factorial design with four replications. The results showed that the cultivation system was the dominant factor. Soilless cultivation significantly increased shoot fresh weight (307–344 g), plant height (265–326 cm), number of fruits (36–54 per plant), and fruit yield (2.7–4.5 kg per plant) compared to soil cultivation (shoot fresh weight: 177–216 g; yield: 0.4–1.0 kg per plant). Conversely, plants grown in soil had higher leaf dry weight percentage, root dry weight percentage, chlorophyll, and carotenoids. The effects of grafting were system dependent, with non-grafted plants performing as well or better in soilless culture, while grafted plants (especially Saba/Routpower combination) showed some soil-based advantages, including greater root length. Foliar calcium did not significantly improve most parameters, indicating that standard nutrient management provided sufficient calcium or that the 200 mg/L concentration was insufficient. Under the conditions tested, ungrafted plants grown without foliar calcium supplementation in soilless culture achieved yields comparable to more complex treatments, suggesting a simpler and more cost-effective production strategy. Full article

Background. When free margins can be achieved and adjacent joints can be preserved, limb salvage surgery is the preferred treatment for intercalary paediatric bone tumours in the lower extremity. Biological reconstruction techniques include allograft, free vascularised fibular graft (FVFG), and allograft combined with FVGF (Capanna technique). This review summarises current evidence on outcomes and complications, and proposes directions for future research to refine patient selection. Methods. A systematic review was conducted using PubMed, Scopus, Embase, and Cochrane Library. Eligible studies reported outcomes of allograft, FVFG, or combined techniques for intercalary lower limb reconstruction in children or adolescents. Results. Twenty-five articles met the inclusion criteria (8 allograft, 7 FVFG, 14 Capanna); four studies reported two techniques. In total, 391 patients were included (allograft 147, FVFG 51, Capanna 193). Mean defect lengths were 14.9 cm (allograft), 14.5 cm (FVFG), and 14.7 cm (Capanna). Time to union was 8.5 months for allografts, 11.4 for Capanna, and 12.5 for FVFG. Non-union occurred in 14.7%, 13.2%, and 10.3%, and delayed union in 13.6%, 4.8%, and 7.9% for FVFG, allograft, and Capanna, respectively. Fractures were 40.5% for FVFG, 18.4% for allograft, and 23.5% for Capanna. Infections were least common with FVFG (2.7%). Conclusions. The reconstruction strategy should be tailored to anatomical location, defect size, and patient-specific factors. Although infections rates were lowest with FVFG, time to union was longer and the postoperative fracture rate was higher compared to the allograft or Capanna technique. Allografts demonstrated the shortest time to union and lowest fracture risk. The Capanna technique may be beneficial when factors including chemotherapy, poor host bone quality, or high mechanical load are present, but comes at a cost of morbidity and complexity. Full article

Background: Platelet-rich fibrin (PRF) has been increasingly investigated as a biological adjunct in maxillary sinus augmentation procedures because of its potential to enhance bone regeneration and graft remodelling. However, the histologic benefits of combining PRF with allograft or xenograft materials during lateral sinus augmentation remain unclear. This systematic review aimed to evaluate the histomorphometric outcomes of PRF-modified graft materials compared with graft materials alone in lateral maxillary sinus augmentation. Methods: This systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261301066). Electronic searches were performed in PubMed, Cochrane Library, and Google Scholar databases for studies published within the last 10 years. Randomized controlled trials and split-mouth randomized studies evaluating histologic and histomorphometric outcomes following lateral sinus augmentation using allograft or xenograft materials with and without PRF were included. A random-effects meta-analysis was conducted, and effect estimates were expressed as Hedges’ g and presented with corresponding 95% confidence intervals (CIs). Results: Four randomized clinical studies involving lateral sinus augmentation procedures were included. Histomorphometric findings generally demonstrated higher percentages of newly formed bone and lower residual graft material in PRF-treated groups compared with graft materials alone. Meta-analyses showed a significant increase in newly formed bone, favouring PRF (effect size 0.61; 95% CI: 0.15 to 1.08; p = 0.01), and a significant reduction in residual graft material (effect size −0.65; 95% CI: −1.15 to −0.14; p = 0.01). No statistically significant differences were observed regarding connective tissue/marrow spaces or radiographic bone height. Heterogeneity among studies was low to moderate. Conclusions: The adjunctive use of PRF during lateral maxillary sinus augmentation appears to enhance early bone regeneration and graft remodelling by increasing newly formed bone and reducing residual graft particles. However, radiographic bone dimensions were generally comparable between PRF-treated and control groups. PRF may therefore be considered a promising biological adjunct rather than a substitute for conventional grafting materials. Further standardized randomized clinical trials with larger sample sizes are required to clarify its long-term clinical effectiveness. Full article

Introduction: While global burden is underappreciated, traumatic wounds account for 23 million annual emergency department visits in the United States, accounting for trillions in medical costs and work and quality of life loss. We hypothesized that the use of intact fish skin grafts (IFSGs) would result in faster time to obtain a graftable wound bed compared to a synthetic matrix (SM). Methods: This retrospective analysis of patients with full-thickness acute traumatic wound was conducted on a matched sample of patients receiving IFSG versus SM. We hypothesized that there would be at least a 10-day difference between the two treatments. Two surgeons reviewed electronic charts for primary outcomes. Incomplete charts were excluded. For sensitivity analysis, both simple linear regression and generalized linear mixed models were utilized to adjust the primary outcome to potential confounders. Results: Data were reviewed for 80 patients. The final cohort included 38 patients [IFSG (n = 12) and SM (n = 26)]. Demographics were not different between groups. The mean age was 42.4 ± 20.7 years, with 62.2% being male and equal proportions having burns treated vs. another traumatic wound. The most common site was the lower extremity. All IFSG patients had negative pressure wound therapy (NPWT) placed at the time of implantation vs. 50% of SM (p = 0.001). The SM group had a larger TBSA (p < 0.001) and wound size (p = 0.001). Differences were subsequently used to adjust primary outcomes via regression. Patients with IFSG had faster time to a graftable wound bed compared to SM (mean ± SD: 13.9 ± 5.3 vs. 29.1 ± 10.3, p < 0.001). Neither wound size, burn severity, presence of infection, nor use of NPWT significantly altered the inference. Conclusions: In this paired sample, the use of IFSG as a dermal template for full-thickness traumatic injuries was associated with faster time to obtain a graftable wound bed compared to an SM. However, regression analysis alone is not enough to conclude that the same difference would exist in a prospectively controlled experiment, which should be performed. Full article