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Abstract Peri-implantitis is a common complication characterized by inflammation in tissues surrounding dental implants due to plaque accumulation, which can lead to implant failure. While air flow abrasive treatment has been found to be effective for debriding implant surfaces, little is known about the factors that affect its cleaning capacity. This study systematically examined the cleaning capacity of air powder abrasive (APA) treatment with β-tricalcium phosphate (β-TCP) powder, using various powder jetting strengths and different particle sizes. Three sizes of β-TCP powder (S, M, and L) were prepared, and different powder settings (low, medium, and high) were tested. The cleaning capacity was determined by quantifying ink removal, which simulated biofilm removal from the implant surfaces at different time points. The results of the systematic comparisons showed that the most efficient cleaning of implant surfaces was achieved using size M particles with medium setting. Additionally, the amount of powder consumed was found to be critical to cleaning efficiency, and the implant surfaces were altered in all tested groups. These systematically analyzed outcomes may provide insights into the development of potential non-surgical strategies for treating peri-implant diseases.

Postoperative adhesion is one of the most common complications that occur during and after surgery; thus, materials that can prevent adhesion are often applied. Starch powders with a high water absorption capacity are preferred, and many studies have focused on increasing the water absorption of modified starches, as native starch powders display poor water-holding capacities. The effects of salts on the physical properties of acetylated distarch phosphate potato starch powders were investigated here. Changes in functional groups, the crystal structures of modified starch, particle morphologies, water absorption, viscosity, and in vivo adhesion were investigated. The results showed that salts greatly improved the water absorption and viscosity of acetylated distarch phosphate potato starch powders. Among the three different salt-modified starch powders, NaCl-modified starch powders displayed higher water absorption and viscosity and demonstrated better in vivo anti-adhesion performance. The results of this study propose a potential biomaterial that may function as an anti-adhesive, potentially leading to reduced surgical risks and a better quality of life for patients.

The goal of this paper is to examine the use of pig blood in the industrial mass production of platelet dry powder and to transform platelet dry powder into a low-cost and mass-produced material. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) contain multiple types of growth factors (GFs) and can be widely used in medical applications. However, neither can be mass-produced, due to the complexity of the PRP preparation process and the lack of anticoagulants in the PRF preparation process, increasing the risk of coagulation during mass production. Another obstacle is the insufficient supply of autologous PRP and autologous PRF. In this study, platelet dry powder was mass-produced from pig blood through the indirect addition of calcium chloride solution. Furthermore, the results showed that different concentrations and percentages of calcium chloride solution had significant effects on concentrations of TGF-β1 and PDGF-BB in the platelet dry powder. The platelet dry powder mass-produced from pig blood demonstrated high concentrations of GFs and long-term shelf stability, increasing the supply to industries that use it in product development.

Background: Due to the increasing need for suitable alternatives to bone grafts, artificial bones made of biphasic calcium phosphate (BCP) are currently being extensively researched. These porous bone substitutes have also demonstrated considerable incorporation with the host bone, and new bone is able to grow within the porous structure. They therefore offer a potential therapeutic approach for bone defects.Methods: Vancomycin-loaded Bicera™, a BCP bone substitute, was investigated in order to prevent implant-associated osteomyelitis and postoperative infection after orthopedic surgery. The loading capacity of Bicera™ was measured to understand its potential antibiotic adsorption volume. An antibiotic susceptibility test was also carried out to analyze the effect of Bicera™ loaded with different concentrations of vancomycin on the growth inhibition of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin-loaded Bicera™ was implanted into rabbits with bone defects, and general gross, radiographic, and histological evaluation was undertaken at 4, 12, and 24 weeks after implantation.Results: The maximum loading capacity of vancomycin-loaded Bicera™ was 0.9 ml of liquid regardless of the vancomycin concentration. Antibiotic susceptibility tests showed that vancomycin-loaded Bicera™ inhibited the growth of MRSA for 6 weeks. In addition, animal studies revealed that new bone grew into the vancomycin-loaded Bicera™. The percentage of new bone formation from 4 to 24 weeks after implantation increased from 17% to 36%.Conclusion: Vancomycin-loaded Bicera™ could effectively inhibit the growth of MRSA in vitro. It was found to incorporate into the host bone well, and new bone was able to grow within the bone substitute. The results of this study indicate that vancomycin-loaded Bicera™ is a potential bone substitute that can prevent implant-associated osteomyelitis and postoperative infection.

The average lifespan of artificial joints is 15–25 years, but it is still too short for young and active patients. Human synovial albumin is easily adsorbed on the surfaces of artificial joint materials and has increased friction when subjected to conformational changes. Most studies have focused on the interaction between synovial fluid components and artificial joints when protein conformation has not been modified, but not on how to reduce friction and wear caused by denatured proteins. This study aimed to investigate whether hyaluronic acid could provide lubrication for albumin-mediated friction when high friction was caused by the disrupted secondary structure of albumin. Thermally processed human synovial albumin was used as denatured protein while friction testing, measurement of conformation, adsorption, and viscosity analysis were investigated. The results demonstrated that adding fresh hyaluronic acid to thermally processed albumin solution could reduce 50% of the friction coefficient caused by totally disrupted albumin. The viscosity of thermally processed albumin with fresh hyaluronic acid increased 40 times more than denatured albumin alone, and the adsorbed albumin area with fresh hyaluronic acid increased twice. The results showed hyaluronic acid provided lubrication by increasing the viscosity for friction mediated by denatured albumin, and it may provide a potential solution for prolonging the lifespan of artificial joints.

The purpose of this study was to develop and empirically test a model for predicting the key factors affecting nurses’ behavioral intention to use mobile learning (m-learning). We explored behavioral intention from users’ perspectives by applying an extended unified theory of acceptance and use of technology (UTAUT) model with the addition of information quality, system quality, technostress, and satisfaction. We conducted a survey of the district and regional hospitals in central Taiwan. Data were derived from 434 respondents. Structural equation modeling was applied to analyze the causal effects of 15 hypothesized predictive factors. We determined that satisfaction, social influence, performance expectancy, facilitating conditions, and effort expectancy positively impacted nurses’ behavioral intention to use m-learning. In addition, technostress was a negative antecedent of effort expectancy. Information quality and system quality had significantly positive effects on satisfaction, performance expectancy, and effort expectancy. This study provides hospital managers with a reference when assessing future developments and informs approaches to promote m-learning.

Decellularized matrices can effectively reduce severe immune rejection with their cells and eliminated nucleic acid material and provide specific environments for tissue repair or tissue regeneration. In this study, we prepared acellular cartilage matrix (ACM) powder through the decellularization method and developed ACM hydrogels by physical, chemical, and enzymatic digestion methods. The results demonstrated that the small size group of ACM hydrogels exhibited better gel conditions when the concentration of ACM hydrogels was 30 and 20 mg/mL in 1N HCl through parameter adjustment. The data also confirmed that the ACM hydrogels retained the main components of cartilage: 61.18% of glycosaminoglycan (GAG) and 78.29% of collagen, with 99.61% of its DNA removed compared to samples without the decellularization procedure (set as 100%). Through turbidimetric gelation kinetics, hydrogel rheological property analysis, and hydrogel tissue physical property testing, this study also revealed that increasing hydrogel concentration is helpful for gelation. Besides, the ex vivo test confirmed that a higher concentration of ACM hydrogels had good adhesive properties and could fill in cartilage defects adequately. This study offers useful information for developing and manufacturing ACM hydrogels to serve as potential alternative scaffolds for future cartilage defect treatment.

Poloxamers are negatively temperature-sensitive hydrogels and their hydrophilic groups interact with water molecules at lower temperatures (liquid phase) while their hydrophobic groups interact more strongly with increases in temperature causing gelation. To investigate the factors affecting the rheological properties of poloxamers, various parameters including different poloxamer P407 concentrations, poloxamers P407/P188 blending ratios and additives were examined. The results presented a clear trend of decreasing gelling temperature/time when P407 was at higher concentrations. Moreover, the addition of P188 enhanced the gelling temperature regardless of poloxamer concentration. Polysaccharides and their derivatives have been widely used as components of hydrogel and we found that alginic acid (AA) or carboxymethyl cellulose (CMC) reduced the gelling temperature of poloxamers. In addition, AA-containing poloxamer promoted cell proliferation and both AA -and CMC-containing poloxamer hydrogels reduced cell migration. This study investigated the intriguing characteristics of poloxamer-based hydrogel, providing useful information to compounding an ideal and desired thermo-sensitive hydrogel for further potential clinical applications such as development of sprayable anti-adhesive barrier, wound-healing dressings or injectable drug-delivery system for cartilage repair.

The adsorption of tear film compositions such as proteins and lipids on the orthokeratology lenses often lead to infection or corneal damage. In order to investigate whether polysaccharides could prevent tear compositions from being adsorbed on the lens, alginic acid and lambda-carrageenan were added into artificial tear solution. By measuring daily adsorption of cholesterol, lysozyme, and albumin, our results showed that polysaccharides could weakly prevent cholesterol adsorption. In addition, polysaccharides could also reduce albumin deposition over time. Although the effect of polysaccharides on lysozyme adsorption was distinct depending on the concentrations of polysaccharides, the overall results demonstrated that polysaccharides could decrease protein deposition over time. Our results provided an in vitro evidence that polysaccharides may be applied as coating materials on the lens or as the composition of artificial tear solutions or eyedrops, in order to prevent adsorption of tear film compositions that may lead to a reduced incidence of infection or corneal damage for orthokeratology lens wearers.

Background/purpose: The purpose of this study was to investigate whether poly-gamma-glutamic acid (γ-PGA), a naturally derived biomaterial, was suitable as an alternative antibacterial mouthwash in the absence of alcohol. Materials and methods: Three bacterial strains, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, were used for testing the antibacterial activity of mouthwashes. In addition, cell viability, cytotoxicity, and genotoxicity experiments were conducted for testing the toxicity of mouthwashes. Results: We demonstrated that 10000 ppm of γ-PGA without alcohol could efficiently inhibit 99% of bacterial growth. In addition, γ-PGA did not cause any cytotoxicity or genotoxicity. Conclusion: 10000 ppm of γ-PGA in an alcohol-free mouthwash is an alternative biomaterial for mouthwashes. Keywords: Biomaterials, Mouthwash, Poly-gamma-glutamic acid (γ-PGA)

The demand of bone grafting is increasing as the population ages worldwide. Although bone graft materials have been extensively developed over the decades, only a few injectable bone grafts are clinically available and none of them can be extruded from 18G needles. To overcome the existing treatment limitations, the aim of this study is to develop ideal injectable implants from biomaterials for minimally invasive surgery. An injectable composite bone graft containing calcium sulfate hemihydrate, tetracalcium phosphate, and anhydrous calcium hydrogen phosphate (CSH/CaP paste) was prepared with different CSH/CaP ratios and different concentrations of additives. The setting time, injectability, mechanical properties, and biocompatibility were evaluated. The developed injectable CSH/CaP paste (CSH/CaP 1:1 supplemented with 6% citric acid and 2% HPMC) presented good handling properties, great biocompatibility, and adequate mechanical strength. Furthermore, the paste was demonstrated to be extruded from a syringe equipped with 18G needles and exerted a great potential for minimally invasive surgery. The developed injectable implants with tissue repairing potentials will provide an ideal therapeutic strategy for minimally invasive surgery to apply in the treatment of maxillofacial defects, certain indications in the spine, inferior turbinate for empty nose syndrome (ENS), or reconstructive rhinoplasty.

Using barbed thread lifting for facial rejuvenation has become popular these days due to its minimally invasive procedures with reduced complications. However, only limited studies regarding its mechanical properties for face suspension were published. The aim of this study was to evaluate suture-holding ability regarding its facelift property, and different specimens were tested in order to establish an in vitro model. Fresh porcine tissue and the synthetic material polydimethylsiloxane (PDMS) were selected to simulate human skin for evaluating barbed suture pull-out strength by the universal material testing machine. The results showed that the pull-out strength of barbs between different porcine tissues varied without consistency. By contrast, PDMS (30:1) showed more consistent pull-out strength in each testing, and the average maximum load force was close to porcine tissue. Furthermore, after submerging barbed sutures in PBS for 0 days (T0), 7 days (T7) and 14 days (T14), a trend of decreased average maximum load force, displacement and force of 1.5 mm/2 mm/3 mm displacement could be detected by in vitro testing with PDMS (30:1). These results provide support for using PDMS (30:1) to evaluate suture pull-out strength and holding/lifting capacities in vitro to obtain consistent and objective information for evaluating substantial equivalence of devices. The established in vitro method could be used for the future development of barbed thread lifting technology.

Nursing practice courses are the most formative part of nursing education. Through practice, nursing students apply, validate, and clarify theories taught in class. Recently, research on the application of mobile devices in nursing practice courses has advanced rapidly. An e-book system that integrates text, audio, and images can improve a learner’s attention, interest, and creativity. Few studies have explored e-book use in education in regional health centers, and studies that have approached this topic have focused only on the data search and retrieval aspects. To address this gap, the current study introduced an e-book system that integrated project-based learning and authentic learning into a community health nursing practice course. Analysis results of a 3-week experiment indicated that the diverse functions, multimedia features, and convenience of the e-book system not only increased learning interest and motivation but also improved learning effectiveness. However, the cognitive load imposed on nursing students using the e-book system also increased, because they were required to create and edit teaching materials for a new health care education method.

Orthokeratology lenses are commonly used for myopia control, especially in children. Tear lipids and proteins are immediately adsorbed when the lens is put on the cornea, and protein deposition may cause discomfort or infection. Therefore, we established an in vitro protein deposition analysis by mimicking the current cleaning methods for orthokeratology lens wearers for both short-term and long-term period. The results showed that the amounts of tear proteins accumulated daily and achieved a balance after 14 days when the lens was rubbed to clean or not. Protein deposition also affected the optical characteristics of the lens regardless of cleaning methods. Our results provided an in vitro analysis for protein deposition on the lens, and they may provide a potential effective method for developing care solutions or methods that can more effectively remove tear components from orthokeratology lenses.

Demineralized bone matrix (DBM) is a decalcified allo/xenograft retaining collagen and noncollagenous proteins, which has been extensively used because of its osteoconductive and osteoinductive properties. Calcium sulfate (CaSO4, CS) is a synthetic bone substitute used in bone healing with biocompatible, nontoxic, bioabsorbable, osteoconductive, and good mechanical characteristics. This study aims to prepare a DBM/CS composite bone graft material in a moldable putty form without compromising the peculiar properties of DBM and CS. For this purpose, firstly, porcine femur was defatted using chloroform/methanol and extracted by acid for demineralization, then freeze-dried and milled/sieved to obtain DBM powder. Secondly, the α-form and β-form of calcium sulfate hemihydrate (CaSO4·0.5H2O, CSH) were produced by heating gypsum (CaSO4·2H2O). The morphology and particle sizes of α- and β-CSH were obtained by SEM, and their chemical properties were confirmed by EDS, FTIR and XRD. Furthermore, the DBM-based graft was mixed with α- or β-CSH at a ratio of 9:1, and glycerol/4% HPMC was added as a carrier to produce a putty. DBM/CSH putty possesses a low washout rate, good mechanical strength and biocompatibility. In conclusion, we believe that the moldable DBM/CSH composite putty developed in this study could be a promising substitute for the currently available bone grafts, and might have practical application in the orthopedics field as a potential bone void filler.

Calcium sulfate/calcium phosphate (CS-CP)-based bone substitutes have been developed in premixed putty for usage in clinical applications. However, it is difficult to completely stop the bleeding during an operation because premixed putty can come into contact with blood or body fluids leading to disintegration. Under certain conditions depending on particle size and morphology, collapsed (washed) particles can cause inflammation and delay bone healing. In this context, anti-washout premixed putty CS-CP was prepared by mixing glycerin with 1, 2, and 4 wt% of hydroxypropyl methylcellulose (HPMC), and the resultant anti-washout properties were evaluated. The results showed that more than 70% of the premixed putty without HPMC was disintegrated after being immersed into simulated body fluid (SBF) for 15 min. The results demonstrated that the more HPMC was contained in the premixed putty, the less disintegration occurred. We conclude that CS-CP pre-mixed putty with glycerin and HPMC is a potential bone substitute that has good anti-washout properties for clinical applications.

Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement with considerable morbidity and large economic burdens. Antibiotic-Loaded Bone Cement (ALBC) has been developed as a valuable tool for local administration and is becoming one of the most effective methods for the prevention and treatment of orthopedic infections. Controlling antibiotic release from ALBC is critical to achieve effective infection control, however, the antibiotic elution rates are generally low, and the mechanisms are poorly understood. Thus, the present study aims to investigate the effects of the basic acrylic bone cement components, including liquid/powder (monomer-to-polymer) ratios, radiopacifier, initiator, and doses of antibiotics on the porosity, antibiotic elution rates and mechanical properties of polymethylmethacrylate (PMMA) based ALBC. The obtained results from the in vitro studies suggested that a reduction in the liquid/powder ratio and an increase in the radiopacifier ratio and gentamicin doses led to increased porosity and release of antibiotic, while the initiator ratio exerted no effect on elution rates. In conclusion, we hope that by varying the composition of ALBC, we could considerably enhance the antibiotic elution rates by increasing porosity, while maintaining an adequate mechanical strength of the bone cements. This finding might provide insights into controlling antibiotic release from ALBC to achieve effective infection control after total joint replacement surgery.

Feeling comfortable is the greatest concern for contact lens wearers, and it has been suggested that in vivo comfort could be corresponded to the in vitro friction coefficient of contact lenses. How tear albumin could affect the friction coefficient of silicone hydrogel and hydrogel contact lenses was analyzed by sliding a lens against a quartz glass in normal and extremely high concentration of albumin solution. Albumin deposition testing and surface roughness analysis were also conducted. The results showed that the friction coefficient of tested contact lenses did not correspond to both the albumin deposition amount and surface roughness, but we proposed a model of how albumin might act as a lubricant on the surface of some hydrogel and silicone hydrogel contact lenses. In conclusion, albumin provided lubrication for silicone hydrogel contact lenses regardless of albumin concentrations, while albumin only acted as a lubricant for hydrogel contact under normal concentration.

Osteoarthritis patients often experience pain and inflammation in joints. To understand whether antioxidant supplements could reduce inflammation and could potentially be applied for osteoarthritis treatment, vitamin E and resveratrol were investigated in this study. Hydrogen peroxide was used for inducing inflammation in porcine chondrocytes, and the lumen density was measured for the level of oxygen-derived free radicals. In total, 5, 50, 100, and 200 μM of vitamin E and resveratrol were analyzed for cell viability and the effect of lumen density. In addition, the expressions of IL-1β, TNF-α, MMP-1, MMP-13, and COL2A1 were investigated when treating chondrocytes with 100 μM vitamin E, 5 μM resveratrol, or their combination before or after hydrogen peroxide induction. Inducing chondrocytes with hydrogen peroxide for 30 min increased the level of lumen density sufficiently and stimulated the expression of inflammatory genes. All the concentrations of vitamin E and resveratrol showed good cell viability. Single treatment with either vitamin E or resveratrol reduced inflammatory gene expression, and combined treatment increased the expression of collagen type II. The results suggested that post-treatment with both vitamin E and resveratrol has a better effect on the reduction in inflammation in osteoarthritis-like chondrocytes.

The ocular discomfort is the leading cause of contact lens wear discontinuation. Although the tear proteins as a lubricant might improve contact lens adaptation, some in vitro studies suggested that the amount of adsorbed proteins could not simply explain the lubricating performance of adsorbed proteins. The purpose of this study was to quantify the structural changes and corresponding ocular lubricating properties of adsorbed protein on a conventional contact lens material, poly (2-hydroxyethyl methacrylate) (pHEMA). The adsorption behaviors of lysozyme on pHEMA were determined by the combined effects of protein–surface and protein–protein interactions. Lysozyme, the most abundant protein in tear, was first adsorbed onto the pHEMA surface under widely varying protein solution concentrations to saturate the surface, with the areal density of the adsorbed protein presenting different protein–protein effects within the layer. These values were correlated with the measured secondary structures, and corresponding friction coefficient of the adsorbed and protein covered lens surface, respectively. The decreased friction coefficient value was an indicator of the lubricated surfaces with improved adaptation. Our results indicate that the protein–protein effects help stabilize the structure of adsorbed lysozyme on pHEMA with the raised friction coefficient measured critical for the innovation of contact lens material designs with improved adaptation.

Feeling comfortable is an important issue for contact lens wearers as contact lenses are worn for an extensive period of time. It has been shown that the in vitro friction coefficient of contact lenses is correlated to the degree of in vivo comfort, thus many studies focus on establishing friction testing methods for investigating the friction coefficient of contact lenses or contact lens care solution. We have previously demonstrated the lubricating property of poly-gamma-glutamic acid (γ-PGA)-containing care solution, and it could reduce the high friction coefficient caused by lysozyme. However, the mechanism of how γ-PGA-containing care solution reduces the lysozyme-induced friction coefficient of contact lenses is unclear. We investigated the bio-tribological effect of γ-PGA on ionic contact lenses in the presence of lysozyme by testing load and velocity variations. The ability to remove lysozyme deposition by γ-PGA and viscosity analysis of γ-PGA-containing care solutions were also investigated to understand the potential mechanism. Our results showed that the friction coefficient of γ-PGA-containing care solution with lysozyme was the lowest in both load and velocity variations, and γ-PGA functions distinctly in the lysozyme-ionic contact lens system. We proposed a model of how γ-PGA could reduce the friction coefficient in these two conditions.

In order to perform the multiple functions of disinfection, cleansing, and storage, preservatives are often added to contact lens care solutions. The disadvantage of adding preservatives is that this often causes various eye conditions. However, lens care solutions would not be able to disinfect in the absence of such preservatives. In addition, comfort is an important issue for contact lens wearers due to the long periods of time they are worn. It has been shown that lower friction coefficients are correlated with increased comfort. We have previously developed a multipurpose contact lens care solution in which poly-gamma-glutamic acid (γ-PGA) was the main ingredient. In this study, we investigated the antimicrobial activity and lubricating property of our care solution. We showed that there was a synergetic effect of γ-PGA and chlorine dioxide on antimicrobial activity. We also demonstrated that γ-PGA functioned as a lubricating agent. Our results provided evidence of γ-PGA acting as a multi-functional polymer that could be applied in contact lens care solutions.

Wear particle-induced biological responses are the major factors for the failure of total joint arthroplasties, but it is possible to improve the lubrication and reduce the wear of an artificial joint system. Polyetheretherketone (PEEK), with ultra-high molecular weight polyethylene, is a suitable bearing material due to its resistance to fatigue strain. However, the effects of major compositions of synovial fluid on the wear of PEEK are unclear. We characterized the effects of three major components of synovial fluid including albumin, globulin, and phospholipids on the morphology and wear rate of PEEK wear particles. Our results demonstrated that the concentrations of albumin and globulin could affect the morphology of PEEK wear particles. In addition, a higher concentration of globulin and phospholipids (12.5 mg/mL) resulted in an increase in the amount of wear particles by 2.8- and 1.7-fold, respectively. In contrast, increasing albumin caused a reduction of wear particle numbers. These results indicate increasing concentration of albumin or reducing concentration of globulin or phospholipids has a better effect on reducing the numbers of wear particles and provides a potential solution of reducing PEEK wear particles, thus it can be more effectively applied in other biomedical systems.

Despite the established emphasis on core competencies in education, academic achievement, particularly grades, remains a prevalent measure within the academic system. Consequently, it is imperative to explore and substantiate the relationship between academic achievement and core competencies. This study aims to investigate the level of core competencies among nursing students and their association with academic achievement. Ninety-nine nursing students from grades 2 to 4 at a university in Taiwan were selected as study participants using convenience sampling. A questionnaire survey was administered utilizing "The Competency Inventory of Nursing Students (CINS)." Variables related to student background, including gender, interest in nursing, and academic achievement, were categorized into grades of general education, basic medicine, nursing compulsory courses, nursing elective courses, and clinical practicum. Data analysis included Pearson's correlation and regression analyses. Findings showed positive correlations between grades in basic medicine, nursing compulsory courses, and nursing elective courses with basic biomedical science competency. Moreover, basic medical grades demonstrated a positive correlation with general nursing clinical skills competency, while only clinical practicum significantly influenced core competencies. Overall, grades, interest in nursing, clinical practicum, and online information survey frequency collectively explained 29% of the total variance in core competencies. The outcomes of this preliminary study may serve as a reference for enhancing the quality of education. [ABSTRACT FROM AUTHOR]

Background/Aim: Surface biomarkers, such as CD44 and CD133, have been demonstrated to be expressed in prostate cancer cells, and our previous study has shown that prostate cancer cell lines could be divided into three groups according to the single and combined expression pattern of CD44 and 133. In order to refine prognostication in prostate cancer cells, we further investigated genetic biomarkers, prostate cancer antigen 3 (PCA3), kallikrein 4 (KLK4), and KLK9 in different prostate cancer cell lines. Materials and Methods: CWR22Rv1, PC3, and DU145 cell lines were cultured until 95% confluence. The single expression of CD44 or CD133 and their combined expression were analyzed by flow cytometry, and gene expression of b-actin, PCA3, KLK4, and KLK9 was analyzed by real-time polymerase chain reaction. Results: The single expression of CD133 was less than 4% in all cell lines examined. PC3 and DU145 cells displayed a high expression of CD44 (>91%), whereas CWR22Rv1 was the only cell line that demonstrated a high co-expression of both CD44 and CD133 (>91%). In addition, PC3 and DU145 displayed low expression of PCA3, KLK4, and KLK9 when compared with their own b-actin expression. In contrast, CWR22Rva showed high expression of PCA3 and KLK4 although KLK9 expression was also low. Conclusion: Both surface and genetic biomarkers should be validated for a more accurate prognosis in prostate cancer. [ABSTRACT FROM AUTHOR]