Magnesium alloy has been implanted in rats to investigate the in vivo degradation behavior of magnesium for bone implant application. After 9 weeks postoperation, 100% implants were fixed and no inflammation was observed. Histological analysis showed new bone was formed around magnesium implant and no difference was found in the histological microstructure of the new bone and the cortical bone. A degradation or reaction layer, which was mainly composed of Ca, P, O, and Mg, was formed on the surface of magnesium alloy implants. High Ca content in the degradation layer displayed that magnesium could promote the deposition of Ca. Residual area calculation has showed that 10-17% magnesium alloy implant has been degraded in vivo. Compared with that of the controlled rats, no increase in serum magnesium and no disorder of kidney were observed after 15 weeks postoperation. After 18 weeks postoperation, 100% magnesium implants were fixed and no inflammation was observed. About 54% magnesium implant has degraded in vivo. Element analysis showed that Zn and Mn in Mg-Mn-Zn alloy distributed homogeneously in the residual magnesium implant, the degradation layer, and the surrounding bone tissue after 18 weeks implantation, indicating that Zn and Mn elements were easily absorbed by bioenvironment.

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In vivo degradation of magnesium alloy implant, the bone response to the magnesium, and the effect of the degradation of magnesium on the blood composition and organs were investigated by using light microscopy and scanning electronic microscopy with energy dispersive spectrum. Magnesium alloy showed different degradation rates in the marrow channel and the cortical bone. More degradation of magnesium implant was observed in the marrow channel than in the cortical bone. New bone tissue formed around the magnesium implants after 6 weeks implantation but no fibrous capsule was found. There existed two distinct layers separating the new bone tissue from the magnesium implant. On the magnesium implant side, crystalline magnesium calcium phosphate formed on the surface of the implant due to the reaction between the implant and blood or body fluid. On the new bone tissue side was a 10-30-microm membrane comprising two distinct layers with many fibroblasts in the layer close to the new bone tissue. The new bone was in tight contact with the implant through the membrane and phosphate layer due to the good osteoconductivity of the phosphate layer. After 10 and 26 weeks postimplantation, more new bone tissues as well as the membrane were found around the implant. However, no apparent increase in the thickness of the membrane was observed with the increasing of the implantation duration. Blood examination has shown that the degradation of the magnesium implant caused little change to blood composition but no disorder to liver or kidneys.

Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

This study suggested that continued daily application of a lower dose of bFGF not only shortens the closure time of human traumatic TMP but also avoids secondary purulent otorrhea.