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Characterization of the inflammatory response to biomaterials using a rodent air pouch model
Hooper, K. A., T. L. Nickolas, et al. (2000), J Biomed Mater Res 50(3): 365-74.
Abstract: Using a rodent air pouch, the inflammatory responses to biomaterials with distinct physical properties and chemical compositions were compared. The polymers examined were expanded poly(tetrafluoroethylene) (ePTFE), silicone, low-density polyethylene (LDPE), poly(L-lactic acid) (PLLA), poly(desaminotyrosyl-tyrosine ethyl carbonate) [poly(DTE carbonate)], and poly(desaminotyrosyl-tyrosine benzyl carbonate) [poly(DTBzl carbonate)]. We found that implantation of disks (4.5-4.8 mm) of these materials into rodent air pouches for 2 days had no effect on the number or type of cells recovered relative to sham controls. With each of the materials, macrophages were the predominant cell type identified (60-75%), followed by granulocytes (20-25%) and lymphocytes (10%). Implantation of poly(DTE carbonate), ePTFE, LDPE, or poly(DTBzl carbonate) into the pouches for 2 days caused an increase in release of superoxide anion by the pouch cells. Cells from pouches containing poly(DTE carbonate) also released more hydrogen peroxide and were more phagocytic. In contrast, PLLA and silicone had no effect on the functional activity of cells recovered from the pouches. Prolonging the implantation time of poly(DTE carbonate) or PLLA to 7 days did not alter the number or type of cells isolated from the pouches. However, cells from pouches containing poly(DTE carbonate) for 7 days continued to produce increased quantities of superoxide anion relative to sham control pouch cells. These results suggest that the air pouch model is a highly sensitive method and therefore useful for evaluating the functional responses of inflammatory cells to biomaterials.

Characterization of the surface biocompatibility of the electrospun PCL-collagen nanofibers using fibroblasts
Zhang, Y. Z., J. Venugopal, et al. (2005), Biomacromolecules 6(5): 2583-9.
Abstract: The effect of nanofiber surface coatings on the cell's proliferation behavior was studied. Individually collagen-coated poly(epsilon-caprolactone) (PCL) nanofibers (i.e., Collagen-r-PCL in the form of a core-shell structure) were prepared by a coaxial electrospinning technique. A roughly collagen-coated PCL nanofibrous matrix was also prepared by soaking the PCL matrix in a 10 mg/mL collagen solution overnight. These two types of coated nanofibers were then used to investigate differences in biological responses in terms of proliferation and cell morphology of human dermal fibroblasts (HDF). It was found that coatings of collagen on PCL nanofibrous matrix definitely favored cells proliferation, and the efficiency is coating means dependent. As compared to PCL, the HDF density on the Collagen-r-PCL nanofiber membrane almost increased linearly by 19.5% (2 days), 22.9% (4 days), and 31.8% (6 days). In contrast, the roughly collagen-coated PCL increased only by 5.5% (2 days), 11.0% (4 days), and 21.0% (6 days). SEM observation indicated that the Collagen-r-PCL nanofibers encouraged cell migration inside the scaffolds. These findings suggest that the Collagen-r-PCL nanofibers can be used as novel functional biomimetic nanofibers toward achieving excellent integration between cells and scaffolds for tissue engineering applications.

Characterization study and five-cycle tests in a fixed-bed reactor of titania-supported nickel oxide as oxygen carriers for the chemical-looping combustion of methane
Corbella, B. M., L. F. de Diego, et al. (2005), Environ Sci Technol 39(15): 5796-803.
Abstract: Recent investigations have shown that in the combustion of carbonaceous compounds CO2 and NOx emissions to the atmosphere can be substantially reduced by using a two stage chemical-looping process. In this process, the reduction stage is undertaken in a first reactor in which the framework oxygen of a reducible inorganic oxide is used, instead of the usual atmospheric oxygen, for the combustion of a carbonaceous compound, for instance, methane. The outlet gas from this reactor is mostly composed of CO2 and steam as reaction products and further separation of these two components can be carried out easily by simple condensation of steam. Then, the oxygen carrier found in a reduced state is transported to a second reactor in which carrier regeneration with air takes place at relatively low temperatures, consequently preventing the formation of thermal NOx. Afterward, the regenerated carrier is carried to the first reactor to reinitiate a new cycle and so on for a number of repetitive cycles, while the carrier is able to withstand the severe chemical and thermal stresses involved in every cycle. In this paper, the performance of titania-supported nickel oxides has been investigated in a fixed-bed reactor as oxygen carriers for chemical-looping combustion of methane. Samples with different nickel oxide contents were prepared by successive incipient wet impregnations, and their performance as oxygen carriers was investigated at 900 degrees C and atmospheric pressure in five-cycle fixed-bed reactor tests using pure methane and pure air for the respective reduction and regeneration stages. The evolution of the outlet gas composition in each stage was followed by gas chromatography, and the involved chemical, structural, and textural changes of the carrier in the reactor bed were studied by using different characterization techniques. From the study, it is deduced that the reactivity of these nickel-based oxygen carriers is in the two involved stages and almost independent of the nickel loading. However, in the reduction stage, carbon deposition, from the thermal decomposition of methane, and CO emissions, mainly derived from the partial reduction of titania as support acting as an additional oxygen source, may impose some constraints to the efficiency of the overall chemical-looping combustion process in CO2 capture.

Characterizing three-dimensional topography of engineering and biomaterial surfaces by confocal laser scanning and stylus techniques
Wennerberg, A., R. Ohlsson, et al. (1996), Med Eng Phys 18(7): 548-56.
Abstract: Three-dimensional measurements of surface topography were performed using a confocal laser scanner and a contact stylus instrument. Three surfaces known to be difficult to evaluate were chosen to be measured on the same area with the two instruments. The measurements from the optical and the contact stylus profilometer were compared with each other and with measurements obtained from high-resolution atomic force microscopy, which served as a reference instrument. Six implants manufactured from commonly used biomaterials were also measured on the same part of the implant, but not on the same area, with the optical and the contact profilometer in order to simulate the measurements that would be performed when different laboratories measure similarly treated surfaces. The numerical and visual differences achieved when measuring the same area with the two instruments investigated were compared. In general, we found an underestimation of the surface features with the contact stylus measurement and an overestimation with the confocal scanner. The stylus readings are mainly influenced by the radius of the stylus tip, the pressure of the stylus tip on the surface, and the hardness of the material. The optical profilometer has a tendency for creating spikes when surfaces with deep slopes are measured. For relatively soft metallic biomaterials, we found that using the optical instrument is the most appropriate method for surface roughness characterization, particularly when screw-shaped implants are analysed, whereas the stylus is preferred when larger areas with substantial slopes within the surface structure are to be evaluated.

Charged polypeptide vesicles with controllable diameter
Holowka, E. P., D. J. Pochan, et al. (2005), J Am Chem Soc 127(35): 12423-8.
Abstract: We report the preparation and characterization of charged, amphiphilic block copolypeptides that form stable vesicles and micelles in aqueous solution. Specifically, we prepared and studied the aqueous self-assembly of a series of poly(L-lysine)-b-poly(L-leucine) block copolypeptides, KxLy, where x ranged from 20 to 80 and y ranged from 10 to 30 residues, as well as the poly(L-glutamatic acid)-b-poly(L-leucine) block copolypeptide, E60L20. Furthermore, the vesicular assemblies show dynamic properties, indicating a high degree of membrane fluidity. This characteristic provides stimuli-responsive properties to the vesicles and allows fine adjustment of vesicle size using liposome-based extrusion techniques. Vesicle extrusion also provides a straightforward means to trap solutes, making the vesicles promising biomimetic encapsulants.

Chemical and mechanical properties of metallic implant biomaterials
Curtis, J. W., Jr. (1986), J Tenn Dent Assoc 66(2): 44-6.

Chemical changes in hydroxyapatite biomaterial under in vivo and in vitro biological conditions
Orly, I., M. Gregoire, et al. (1989), Calcif Tissue Int 45(1): 20-6.
Abstract: The introduction of a synthetic calcium phosphate into a biological environment is likely to result in surface-mediated chemical events. On the basis of such an assessment, we studied the chemical changes occurring in the mineral after exposure of a synthetic hydroxyapatite ceramic to both in vivo (implantation in human) and in vitro (cell culture) conditions. A small amount of the material was phagocytized but the major remaining part behaved as a secondary nucleator as evidenced by the appearance of a newly formed mineral. Morphologically, the newly formed mineral appeared as tiny crystals precipitated and grown from the surface of the initial synthetic crystals. The density of the additional mineral increased from the periphery to the core of each biomaterial aggregate. Chemically, it was identified by IR spectroscopy as a carbonated apatitic mineral. We propose that the adsorption of biomolecules could inhibit precipitation, accounting for the increasing amount of precipitate from the periphery to the core of the aggregates.

Chemical coupling of photocatalysis with flocculation and adsorption in the removal of organic matter
Shon, H. K., S. Vigneswaran, et al. (2005), Water Res 39(12): 2549-58.
Abstract: An experimental investigation was made to study the effects of chemical coupling of flocculation and adsorption with photocatalysis in treating persistent organic pollutants in wastewater. The photocatalysis alone showed initial reverse reaction when titanium oxide (TiO(2)) was used in catalysis. The effect of the pretreatment of adsorption with powdered activated carbon (PAC) on photocatalysis was studied. The results showed that PAC adsorption followed by photocatalysis was not effective in alleviating reverse reaction. On the other hand, when PAC and TiO(2) were added simultaneously, the reverse reaction was eliminated. Further, the organic removal was also improved by simultaneous PAC and TiO(2) additions. When flocculation with ferric chloride (FeCl(3)) was used as pretreatment, the organic removal efficiency was superior. The initial reverse reaction was also eliminated/minimized. However, inadequate doses of FeCl(3) (less than 30 mgl(-1)) resulted in initial reverse reaction and inferior DOC removal.

Chemically functionalized water soluble single-walled carbon nanotubes modulate neurite outgrowth
Ni, Y., H. Hu, et al. (2005), J Nanosci Nanotechnol 5(10): 1707-12.
Abstract: We report the use of chemically-functionalized water soluble single-walled carbon nanotube (SWNT) graft copolymers for modulation of outgrowth of neuronal processes. The graft copolymers were prepared by the functionalization of SWNTs with poly-m-aminobenzene sulphonic acid and polyethylene glycol. When added to the culturing medium, these functionalized water soluble SWNTs were able to increase the length of various neuronal processes.

Chemically modified collagen: a natural biomaterial for tissue replacement
Nimni, M. E., D. Cheung, et al. (1987), J Biomed Mater Res 21(6): 741-71.
Abstract: Glutaraldehyde crosslinking of native or reconstituted collagen fibrils and tissues rich in collagen significantly reduces biodegradation. Other aldehydes are less efficient than glutaraldehyde in generating chemically, biologically, and thermally stable crosslinks. Tissues crosslinked with glutaraldehyde retain many of the viscoelastic properties of the native collagen fibrillar network which render them suitable for bioprostheses. Implants of collagenous materials crosslinked with glutaraldehyde are subject long-term to calcification, biodegradation, and low-grade immune reactions. We have attempted to overcome these problems by enhancing crosslinking through bridging of activated carboxyl groups with diamines and using glutaraldehyde to crosslink the epsilon-NH2 groups in collagen and the unreacted amines introduced by aliphatic diamines. This crosslinking reduces tissue degradation and nearly eliminates humoral antibody induction. Covalent binding of diphosphonates, specifically 3-amino-1-hydroxypropane-1, 1-diphosphonic acid (3-APD), and chondroitin sulfate to collagen or to the crosslink-enhanced collagen network reduces its potential for calcification. Platelet aggregation is also reduced by glutaraldehyde crosslinking and nearly eliminated by the covalent binding of chondroitin sulfate to collagen. The cytotoxicity of residual glutaraldehyde--leaching through the interstices of the collagen fibrils or the tissue matrix--and of reactive aldehydes associated with the bound polymeric glutaraldehyde can be minimized by neutralization and thorough rinsing after crosslinking and storage in a nontoxic bacteriostatic solution.

Chemiluminescent responses of macrophages exposed to biomaterials: a biocompatibility screening test
Barth, E., T. Sullivan, et al. (1988), J Invest Surg 1(4): 291-7.
Abstract: Chemiluminescence (CL) response of alveolar macrophages (AM) exposed to either phagocytosable or nonphagocytosable particles of polymethylmethacrylate (PMMA) or titanium in vitro was monitored. The results were correlated to known in vivo bone tissue compatibility of the materials. Moreover, the quantity and morphology of adherent AM on titanium and PMMA disks were assessed using scanning electron microscopy (SEM). Our results with PMMA indicated that a high CL response to phagocytosable as well as nonphagocytosable particles of the biomaterial in question, correlated with poor bone tissue compatibility. By contrast, a low CL response to phagocytosable particles and no response to nonphagocytosable particles correlated with a satisfactory bone tissue compatibility, as in the case of titanium. SEM showed 48% more AM adherent to PMMA than titanium per unit area. Also, the percentage of cells with membrane damage was three times higher on PMMA than on titanium. It appears that the CL response of AM exposed to biomaterials in vitro thus can be used as an easy to do screening test for potential orthopaedic implant materials before in vivo tests are considered.

Chin and prejowl augmentation in the management of the aging jawline
Romo, T., H. Yalamanchili, et al. (2005), Facial Plast Surg 21(1): 38-46.
Abstract: The effects of aging in the lower face and neck are reflected in the contour of the jawline. Soft tissue atrophy, the formation of jowls, and retrusion of the chin are all age-associated changes that contrast starkly with the smooth harmony of a young lower face. These soft tissue changes in the jawline are exacerbated by the effects of aging on the bony portion of the mandible. Bone resorption of the mandible seen with aging can lead to the development of a hypoplastic mentum and the formation of an anterior mandibular groove. Rhytidectomy serves to address the soft tissue changes from aging but cannot counter the effects of aging on the bony mandible itself. Understanding the effects of bone resorption on the aging mandible allows the facial plastic surgeon to augment the mandible appropriately to achieve a more effective rejuvenation of the lower face. The aging process in the mandible and the development of the prejowl sulcus are reviewed. The use of chin and prejowl augmentation as a valuable adjuvant to facelift surgery is discussed.

Chitin, chitosan, and co-products: chemistry, production, applications, and health effects
Shahidi, F. and R. Abuzaytoun (2005), Adv Food Nutr Res 49: 93-135.

Chitin-based embolic materials in the renal artery of rabbits: pathologic evaluation of an absorbable particulate agent
Kwak, B. K., H. J. Shim, et al. (2005), Radiology 236(1): 151-8.
Abstract: PURPOSE: To prospectively evaluate the tissue reaction to and the embolic effect and absorption of chitin and chitosan microspheres and polyvinyl alcohol (PVA) in the renal artery of rabbits. MATERIALS AND METHODS: This experiment was performed in accordance with regulations on animal care and experiments. Thirty-six New Zealand white rabbits were divided into four groups according to the materials (PVA, chitin particles, and chitosan particles, and chitosan microspheres; diameter, 150-250 microm) used for embolization of the right renal artery. A rabbit from each group was sacrificed 1 and 3 days and 1, 2, 4, 8, 16, 24, and 32 weeks after embolization. Gross and microscopic pathologic findings were examined with hematoxylin-eosin, Masson trichrome, and Victoria blue staining. RESULTS: Gross pathologic findings were examined, and swelling of embolized kidneys was observed 1 and 3 days after embolization, whereas shrinkage of the embolized kidneys was consistently seen after 2 weeks, with a hard consistency and nodular surfaces being noted. At histologic analysis, chitosan microspheres filled the lumen more compactly than did other particles. With PVA, a large amount of capillary formations occurred within the embolized arteries, whereas chitin particles and chitosan microspheres showed a lower rate of capillary formation. The shape of all embolic materials remained intact until week 8, at which time the materials gradually decreased in size and number. The chitosan particles and the chitosan microspheres were absorbed around weeks 16 and 24, respectively. CONCLUSION: Chitosan microspheres have great potential as a new embolic material since they block blood vessels more compactly with a lower rate of capillary formation. This material is biocompatible, and it is absorbed 24 weeks after embolization.

Chitooligosaccharides--preparation with the aid of pectinase isozyme from Aspergillus niger and their antibacterial activity
Kittur, F. S., A. B. Vishu Kumar, et al. (2005), Carbohydr Res 340(6): 1239-45.
Abstract: An isozyme of pectinase from Aspergillus niger with polygalacturonase activity caused chitosanolysis at pH 3.5, resulting in low-molecular weight chitosan (86%), chitooligosaccharides (COs, 4.8%) and monomers (2.2%). HPLC showed the presence of COs with DP ranging from 2 to 6. Charcoal-Celite chromatography and re-N-acetylation of the COs followed by CD, IR, MALDI-TOF-MS and FAB-MS analyses revealed an abundance of chitobiose, chitotriose and chitotetraose. The COs-monomeric mixture showed a bactericidal effect towards Bacillus cereus and Escherichia coli more efficiently than native chitosan. Among the chitooligomers, the hexamer showed maximum antibacterial effect followed by the penta-, tetra-, tri- and dimers. Of the two monomers, only GlcN showed slight bacterial growth inhibition. SEM revealed bactericidal action patterns of COs-monomeric mixture towards B. cereus and E. coli.

Chitosan (biochikol 020 PC) in the control of some ornamental foliage diseases
Wojdyla, A. T. (2004), Commun Agric Appl Biol Sci 69(4): 705-15.
Abstract: Chitosan, (Biochikol 020 PC) a potential elicitor of plant defence and also an active inhibitor of fungal growth was used in experiments. The compound was used at concentrations 0.01 to 0.2% as a plant spray for rose protection against Sphaerotheca pannosa var. rosae, Peronospora sparsa and Diplocarpon rosae, Oidium chrysanthemi and Puccinia horiana on chrysanthemum, against Melampsora epitea on willow. Myrothecium roridum on dieffenbachia and against Lophodermium spp on Scots pine. Effectiveness of this product, applied curatively 2-times at 7-day-intervals after appearance of rose powdery mildew symptoms on most of plant parts, was about 32%. When compound was applied just after the first disease symptoms appearance, after 2-week-protection its effectiveness was about 43-60%. After 4 weeks, effectiveness of chitosan (Biochikol 020 PC) increased and ranged from 67 to 77%. In the control of P. sparsa on rose shrubs, growing in plastic tunnel, chitosan at conc. 0.025% was applied 4 times at weekly intervals. Effectiveness of chitosan against this pathogen was over 72%, similar as standard fungicide. Increase of chitosan (Biochikol 020 PC) concentration resulted in decrease of its effectiveness. In case of D. rosae control, chitosan used 9 times at weekly intervals was applied after first disease symptoms. After 3-week-protection effectiveness of the compound varied from 18 to 60% according to used concentration. After 9 weeks of protection effectiveness of tested product ranged from 16 to 23% and was connected with used concentration. Increase of chitosan concentration resulted in better protection of rose shrubs. Effectiveness of chitosan (Biochikol 020 PC) used 4-times at conc. 0.01 to 0.05% as chrysanthemum spray in the control of Oidium chrysanthemi ranged from 69 to 79%, whereas against Puccinia horiana from 54-97%. Two-time-spraying of willow with rust symptoms (Melampsora epitea) with chitosan at conc. 01-0.04% caused decrease of disease severity from 26 to 47%. Additionally about 10 to 25% of uredinia were dried up. Chitosan (Biochikol 020 PC) applied for leaf spraying inhibited the development of Myrothecium leaf spot on dieffenbachia more than 85%. Curative application of the compound controlled Myrotecium leaf spot at about 40%. Chitosan efficacy was also tested against one-year-old Pinus sylvestris seedlings growing in field conditions. Plants were sprayed fortnightly 14-times (long programme) or 5-times (short programme) against Lophodermium spp. Observations made during next spring showed that effectiveness of chitosan (Biochikol 020 PC) was more than 50% (long programme) and below 50% (short programme).

Chitosan and poly(methyl vinyl ether-co-maleic anhydride) microparticles as nasal sustained delivery systems
Cerchiara, T., B. Luppi, et al. (2005), Eur J Pharm Biopharm 61(3): 195-200.
Abstract: An original dosage form for nasal delivery based on the encapsulation of hydrophilic drug in chitosan-poly(methyl vinyl ether-co-maleic anhydride) (CH-PVM/MA) microparticles prepared by spray-drying technique was developed. Microparticles were characterized in terms of morphology, size, swelling properties, encapsulation efficiency and drug release. The physical state of the drug and the polymer was determined by scanning electron microscopy (SEM) and infrared spectroscopy (IR). Propranolol hydrochloride (PH) was a beta-blocker, used for the treatment of hypertension and was chosen as a model of hydrophilic drug. SEM studies showed spherical particles with smooth surfaces for chitosan hydrochloride (CH-HCl), whereas rather gross surface defects resulted from the incorporation of poly(methyl vinyl ether-co-maleic anhydride) (PVM/MA). In vitro release studies revealed a sustained release of propranolol HCl from microparticles and in particular chitosan hydrochloride provided the lowest release of drug.

Chitosan based surfactant polymers designed to improve blood compatibility on biomaterials
Sagnella, S. and K. Mai-Ngam (2005), Colloids Surf B Biointerfaces 42(2): 147-55.
Abstract: We developed chitosan based surfactant polymers that could be used to modify the surface of existing biomaterials in order to improve their blood compatibility. These polymers consist of a chitosan backbone, PEG side chains to repel non-specific protein adsorption, and hexanal side chains to facilitate adsorption and proper orientation onto a hydrophobic substrate via hydrophobic interactions. Since chitosan is a polycationic polymer, and it is thrombogenic, the surface charge was altered to determine the role of this charge in the hemocompatibility of chitosan. Charge had a notable effect on platelet adhesion. The platelet adhesion was greatest on the positively charged surface, and decreased by almost 50% with the neutralization of this charge. A chitosan surface containing the negatively charged SO(3)(-) exhibited the fewest number of adherent platelets of all surfaces tested. Coagulation activation was not altered by the neutralization of the positive charge, but a marked increase of approximately 5-6 min in the plasma recalcification time (PRT) was displayed with the addition of the negatively charged species. Polyethylene (PE) surfaces were modified with the chitosan surfactant resulting in a significant improvement in blood compatibility, which correlated to the increasing PEG content within the polymer. Adsorption of the chitosan surfactants onto PE resulted in approximately an 85-96% decrease in the number of adherent platelets. The surfactant polymers also reduced surface induced coagulation activation, which was indicated by the PEG density dependent increase in PRTs. These results indicate that surface modification with our chitosan based surfactant polymers successfully improves blood compatibility. Moreover, the inclusion of either negatively charged SO(3)(-) groups or a high density of large water-soluble PEG side chains produces a surface that may be suitable for cardiovascular applications.

Chitosan beads as molecularly imprinted polymer matrix for selective separation of proteins
Guo, T. Y., Y. Q. Xia, et al. (2005), Biomaterials 26(28): 5737-45.
Abstract: Two kinds of molecularly imprinted polymers were prepared using hemoglobin as the imprinting molecule, acrylamide as the functional monomer, chitosan beads and maleic anhydride-modified chitosan beads as matrixes, respectively. Static adsorbing experimental results showed that an equal class of adsorption was formed in the imprinted polymers and the adsorption equilibrium constant and the maximum adsorption capacity were evaluated. Chromatographic characteristics showed that the column bedded with the hemoglobin imprinted beads could separate hemoglobin and bovine serum albumin effectively from their mixture, which indicates that the imprinted beads have very higher selectivity for hemoglobin than the non-imprinted with the same chemical composition.

Chitosan for overweight or obesity
Ni Mhurchu, C., C. A. Dunshea-Mooij, et al. (2005), Cochrane Database Syst Rev(3): CD003892.
Abstract: BACKGROUND: Chitosan, a deacetylated chitin, is a dietary supplement reported to decrease body weight. It is widely available over the counter worldwide and although evaluated in a number of trials its efficacy remains in dispute. OBJECTIVES: To assess the effects of chitosan as a treatment for overweight and obesity. SEARCH STRATEGY: We searched electronic databases (MEDLINE, EMBASE, BIOSIS, CINAHL, The Cochrane Library), specialised web sites (Controlled Trials, IBIDS, SIGLE, Reuter's Health Service, Natural Alternatives International, Pharmanutrients), bibliographies of relevant journal articles, and contacted relevant authors and manufacturers. Last searches were completed in March 2004. SELECTION CRITERIA: Trials were included in the review if they were randomised controlled trials of chitosan a minimum of four weeks duration in adults who were overweight or obese. Authors of included studies were contacted for additional information where appropriate. DATA COLLECTION AND ANALYSIS: Details from eligible trials were extracted independently by two reviewers using a standardised data extraction form. Differences in data extraction were resolved by consensus. Continuous data were expressed as weighted mean differences and standard deviations. The pooled effect size was computed by using the inverse variance weighted method. MAIN RESULTS: Fourteen trials including a total of 1131 participants met the inclusion criteria. No trial to date has measured the effect of chitosan on mortality or morbidity. Analyses including all trials indicated that chitosan preparations result in a significantly greater weight loss (weighted mean difference -1.7 kg; 95% confidence interval (CI) -2.1 to -1.3 kg; P < 0.00001), decrease in total cholesterol (-0.2 mmol/L; 95% CI -0.3 to -0.1; P < 0.00001), decrease in systolic (-5.9 mmHg; 95% CI -7.3 to -4.6; P < 0.0001) and diastolic (-3.4 mmHg; 95% CI -4.4 to -2.4; P < 0.00001) blood pressure compared with placebo. There were no clear differences between intervention and control groups in terms of frequency of adverse events or in faecal fat excretion. However, the quality of many studies was sub-optimal and analyses restricted to studies that met allocation concealment criteria, were larger, or of longer duration showed that such trials produced substantially smaller decreases in weight and total cholesterol. AUTHORS' CONCLUSIONS: There is some evidence that chitosan is more effective than placebo in the short-term treatment of overweight and obesity. However, many trials to date have been of poor quality and results have been variable. Results obtained from high quality trials indicate that the effect of chitosan on body weight is minimal and unlikely to be of clinical significance.

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