World Health Organization (WHO) in 2005 reported that cases of tuberculosis (TB) in the world occur more than 8 million annually and 5-10% was attacked in spine. The most effective treatment of spinal TB is evacuation of infected bone segments and fills with bone graft. It has been synthesized and characterized of Injectable Bone Substitute (IBS) paste based on hydroxyapatite, gelatin and streptomycin. IBS paste synthesized by mixing hydroxyapatite and gelatin 20% w/v with 75:25, 70:30, 65:35 and 60:40 ratio and streptomycin 10 wt%. The mixture was then added with hydroxypropyl methylcellulose (HPMC) 4% w/v as suspending agent. In vitro characterization performed includes acidity (pH), injectability test, setting time, cytotoxicity (MTT assay) and microbacterium test. Acidity test results indicate a fourth variation of the samples had pH values approaching normal body pH (7.3 to 7.6) and is able to maintain stability when measured in 7 days. Injectability test results indicate IBS paste is injectable with the highest percentage of the injectability value at 97.74% ± 0.19%. IBS paste has been setting within 30 minutes to 1 hour when injected on hydroxyapatite scaffold that resembles the bone cavity and is able to cover the pore scaffold seen from the Scanning Electron Microscope (SEM). Scaffold pore size is smaller from range of 780.8 to 835.4 μm into 225.2 μm. MTT assay results showed that IBS paste is not toxic and experiencing proliferation (viability >100%) that are expected to trigger osteoblast cell growth when applied. Microbacterium test results showed that IBS paste is an antibacterial seen from inhibition zone diameter of Staphylococcus aureus and has a high strength-sensitive antibacterial. Thus, hydroxyapatite, gelatin and streptomycin composites had qualified as injectable bone substitute which applied in cases of spinal tuberculosis.
Based on data from Indonesian Health Ministry in 2009, osteoporosis case reached 19,7 % of the populations in Indonesia, especially women in menopause period. The treatment was performed by consuming bisphosphonate drugs per oral which was not effective since the absorption intake of the drug was only less than 55% of the intake dosage. Because of that, the bone filler which also has a function as drug delivery system was developed. The hydroxyapatite-gelatin bone filler with the addition of alendronate was studied. To increase the characteristics of this bone filler, glutaraldehyde was introduced in the composite as a crosslinking agent. The concentration of 0.25%, 0.5%, and 0.75% were used. The bone filler was then characterized based on FTIR test, morphology test, compressive strength test, cytotoxicity test, and degradation test. The FTIR result showed that there was no significant difference between the sample with and without glutaraldehyde since the crosslinking bond of glutaraldehyde and gelatin was C=N bond which also presented in the gelatin. The morphology of the samples depicted a bigger pore size for higher glutaraldehyde concentration which also supported by lower compressive strength. All the samples were non-toxic based on the cytotoxicity test which had cell viability more than 100%. The degradation tests showed that with the presence of glutaraldehyde in the bone filler could maintain its form longer than the bone filler without glutaraldehyde. In conclusion, the presence of glutaraldehyde could increase the characteristics of the hydroxyapatite-gelatin composite with the addition of alendronate as a bone filler candidate for osteoporotic bone.
The most effective treatment for spinal tuberculosis was by eliminating the tuberculosis bacteria and replacing the infected bone with the bone graft to induce the healing process. This study aims to synthesize and characterize nanohydroxyapatite-gelatin-based injectable bone substitute (IBS) with addition of streptomycin. The IBS was synthesized by mixing nanohydroxyapatite and 20 w/v% gelatin with ratio of 40:60, 45:55, 50:50, 55:45, 60:40, 65:35, 70:30, and 75:25 ratio and streptomycin addition as antibiotic agent. The mixture was added by hydroxypropyl methylcellulose as suspending agent. FTIR test showed that there was a chemical reaction occurring in the mixture, between the gelatin and streptomycin. The result of injectability test showed that the highest injectability of the IBS sample was 98.64% with the setting time between 30 minutes and four hours after injection on the HA scaffold that represents the bone cavity and coat the pore scaffold. The cytotoxicity test result showed that the IBS samples were nontoxic towards BHK-21 fibroblast cells and human hepatocyte cells since the viability cell was more than 50% with significant difference (p-value<0.05). The acidity of the IBS was stable and it was sensitive towards Staphylococcus aureus with significantly difference (p-value<0.05). The streptomycin release test showed that the streptomycin could be released from the IBS-injected bone scaffold with release of 2.5% after 4 hours. All the results mentioned showed that IBS was suitable as a candidate to be used in spinal tuberculosis case.
Anterior Cruciate Ligament (ACL) injuries are becoming more prevalent in athletes. Anterior Cruciatum Ligament Reconstruction (ACLR) surgery was used to treat ACL injuries and resulted in a recurrence rate of 94% due to the biomechanically repaired tissue being weaker than the original tissue. As a result, biodegradable artificial ligaments must be developed that can withstand mechanical stress during neoligament formation and stabilize the ACL. The purpose of this study is to determine the effect of composition variations in polylactic acid (PLA) and polycaprolactone (PCL) used as ACL nanofiber scaffolds on ultimate tensile strength (UTS) and modulus of elasticity, fiber diameter, cytotoxicity level, and degradation level, as well as the PLA-PCL concentration that provides the best value as an ACL scaffold. Electrospinning was used to fabricate the nanofiber scaffold with the following PLA-PCL compositions: A (100:0), B (85:15), C (80:20), D (70:30), and E (0:100) (wt%). The functional group test revealed no new peaks in any of the samples, and the ester group could be identified in the C-O bond at wave numbers 1300–1100 cm−1 and in the C=O bond at wave numbers 1750–1730 cm−1. The average fiber diameter, as determined by SEM morphology, is between 1000 and 2000 nm. The unbraided sample had a UTS range of 1.578–4.387 MPa and an elastic modulus range of 8.351–141.901 MPa, respectively, whereas the braided sample had a range of 0.879–1.863 MPa and 2.739–4.746 MPa. The higher the PCL composition, the lower the percentage of viable cells and the faster the sample degrades. All samples had a cell viability percentage greater than 60%, and samples C, D, and E had a complete degradation period greater than six months. The ideal scaffold, Sample C, was composed of PLA-PCL 80:20 (wt%), had an average fiber diameter of 827 ± 271 nm, a living cell percentage of 97.416 ± 5.079, and a degradation time of approximately 219 days.
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