INTRODUCTION: The aim of this work was the evaluation of surface modification in surgery of normally used hernia implants and thus improving their antimicrobial properties. The modification consisted of applying hybrid nanolayers with immobilized antiseptic substances (metal cations of Ag, Cu, and Zn) by sol-gel method which ensures prolonged effect of these substances and thus enables a greater resistance of the implant towards infection. In this work, attention is drawn to the issue of applying hybrid nanolayers, activation of mesh surfaces by physical plasma modification or ultraviolet C (UV C) radiation, and influence of these modifications on the mechanical properties of the final meshes. Next work will continue concentrating on the issue of antimicrobial efficacy and eventual toxicity of the prepared layers. MATERIALS AND METHODS: Present-day materials of the most commonly used types of implants for reconstruction of the abdominal wall in surgery (polypropylene, polyester, polyvinylidenefluoride) were tested. Optimum conditions of application of nanolayers by sol-gel method and their thermal stabilization were examined first. Surface modification was verified by scanning electron microscope. The surface of implants was first activated for better adhesion by plasma treatment or UV radiation after preliminary tests. Maximum strength and ductility after activation and hybrid nanolayer modification were objectively measured on a universal Testometric tensile testing machine. RESULTS: The results of surface activation of the meshes (by both plasma treatment or UV C radiation) provided similar and satisfactory results, and particular conditions differed based on the type of material of the mesh. Usage of antimicrobial sol AD30 diluted by isopropyl alcohol in 1:1 proportion appear to be optimal. All tested cases of meshes activated by plasma treatment or UV C radiation and with applied nanolayer concluded in a slight reduction of mechanical properties in modified meshes in comparison with the original ones. However, a slight reduction of test values was not of clinical importance. CONCLUSION: It was verified that surface modification of implants by sol-gel method is effective and technically possible, providing hopeful results.
Antimicrobial biocompatible polymers form a group of highly desirable materials in medicinal technology that exhibit interesting thermal and mechanical properties, and high chemical resistance. There are numerous types of polymers with antimicrobial activity or antimicrobial properties conferred through their proper modification. In this review, we focus on the second type of polymers, especially those whose antimicrobial activity is conferred by nanotechnology. Nanotechnology processing is a developing area that exploits the antibacterial effects of broad-scale compounds, both organic and inorganic, to form value-added medical devices. This work gives an overview of nanostructured antimicrobial agents, especially silver ones, used together with biocompatible polymers as effective antimicrobial composites in healthcare. The bactericidal properties of non-conventional antimicrobial agents are compared with those of conventional ones and the advantages and disadvantages are discussed.
- MeSH
- Anti-Infective Agents administration & dosage chemistry MeSH
- Biocompatible Materials chemistry MeSH
- Disinfection * methods MeSH
- Cross Infection microbiology prevention & control transmission MeSH
- Humans MeSH
- Nanostructures * chemistry ultrastructure MeSH
- Nanotechnology MeSH
- Polymers * chemistry MeSH
- Surface Properties MeSH
- Silver * chemistry MeSH
- Equipment and Supplies * microbiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
The prospective uses of tree gum polysaccharides and their nanostructures in various aspects of food, water, energy, biotechnology, environment and medicine industries, have garnered a great deal of attention recently. In addition to extensive applications of tree gums in food, there are substantial non-food applications of these commercial gums, which have gained widespread attention due to their availability, structural diversity and remarkable properties as 'green' bio-based renewable materials. Tree gums are obtainable as natural polysaccharides from various tree genera possessing exceptional properties, including their renewable, biocompatible, biodegradable, and non-toxic nature and their ability to undergo easy chemical modifications. This review focuses on non-food applications of several important commercially available gums (arabic, karaya, tragacanth, ghatti and kondagogu) for the greener synthesis and stabilization of metal/metal oxide NPs, production of electrospun fibers, environmental bioremediation, bio-catalysis, biosensors, coordination complexes of metal-hydrogels, and for antimicrobial and biomedical applications. Furthermore, polysaccharides acquired from botanical, seaweed, animal, and microbial origins are briefly compared with the characteristics of tree gum exudates.
- MeSH
- Anti-Infective Agents chemistry metabolism MeSH
- Biodegradation, Environmental MeSH
- Biomedical Technology MeSH
- Biosensing Techniques MeSH
- Hydrogels metabolism MeSH
- Nanostructures MeSH
- Nanotechnology * MeSH
- Nanofibers chemistry MeSH
- Polysaccharides metabolism MeSH
- Prospective Studies MeSH
- Plant Exudates chemistry metabolism MeSH
- Plant Gums chemistry metabolism MeSH
- Trees chemistry metabolism MeSH
- Green Chemistry Technology MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
Surface of ultra-high-molecular-weight polyethylene (UHMWPE) was modified by chemical methods. Surface was firstly activated by Piranha solution and then grafted with selected amino-compounds (cysteamine, ethylenediamine or chitosan). The next step was grafting of some borane cluster compounds, highly fluorescent borane hydride cluster anti-B18H22 or its thiolated derivative 4,4'-(HS)2-anti-B18H20. Polymer foils were studied using various methods to characterize surface chemistry (X-ray photoelectron spectroscopy), roughness and morphology (atomic force microscopy, scanning electron microscopy), chemistry and polarity (electrokinetic analysis), wettability (goniometry) and photophysical properties (UV-Vis spectroscopy) before and after modification steps. Subsequently some kinds of antimicrobial tests were performed. Immobilization of anti-B18H22 in small quantities onto UHMWPE surface leads to materials with a luminescence. Samples grafted with borane clusters showed significant inhibition of growth for gram-positive bacteria (S. epidermidis). These approaches can be used for (i) luminophores on the base of polymers nanocomposites development and/or (ii) preparation of materials with antimicrobial effects.
Prosthetic joint infection (PJI) is a feared complication of total joint arthroplasty associated with increased morbidity and mortality. There is a growing body of evidence that bacterial colonization and biofilm formation are critical pathogenic events in PJI. Thus, the choice of biomaterials for implanted prostheses and their surface modifications may significantly influence the development of PJI. Currently, silver nanoparticle (AgNP) technology is receiving much interest in the field of orthopaedics for its antimicrobial properties and a strong anti-biofilm potential. The great advantage of AgNP surface modification is a minimal release of active substances into the surrounding tissue and a long period of effectiveness. As a result, a controlled release of AgNPs could ensure antibacterial protection throughout the life of the implant. Moreover, the antibacterial effect of AgNPs may be strengthened in combination with conventional antibiotics and other antimicrobial agents. Here, our main attention is devoted to general guidelines for the design of antibacterial biomaterials protected by AgNPs, its benefits, side effects and future perspectives in PJI prevention.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Biofilms MeSH
- Biocompatible Materials adverse effects MeSH
- Prosthesis-Related Infections * prevention & control MeSH
- Humans MeSH
- Nanoparticles therapeutic use MeSH
- Joint Prosthesis adverse effects MeSH
- Silver Compounds * therapeutic use MeSH
- In Vitro Techniques methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
The aim of this study was to develop an osteo-inductive resorbable layer allowing the controlled elution of antibiotics to be used as a bone/implant bioactive interface particularly in the case of prosthetic joint infections, or as a preventative procedure with respect to primary joint replacement at a potentially infected site. An evaluation was performed of the vancomycin release kinetics, antimicrobial efficiency and cytocompatibility of collagen/hydroxyapatite layers containing vancomycin prepared employing different hydroxyapatite concentrations. Collagen layers with various levels of porosity and structure were prepared using three different methods: by means of the lyophilisation and electrospinning of dispersions with 0, 5 and 15wt% of hydroxyapatite and 10wt% of vancomycin, and by means of the electrospinning of dispersions with 0, 5 and 15wt% of hydroxyapatite followed by impregnation with 10wt% of vancomycin. The maximum concentration of the released active form of vancomycin characterised by means of HPLC was achieved via the vancomycin impregnation of the electrospun layers, whereas the lowest concentration was determined for those layers electrospun directly from a collagen solution containing vancomycin. Agar diffusion testing revealed that the electrospun impregnated layers exhibited the highest level of activity. It was determined that modification using hydroxyapatite exerts no strong effect on vancomycin evolution. All the tested samples exhibited sufficient cytocompatibility with no indication of cytotoxic effects using human osteoblastic cells in direct contact with the layers or in 24-hour infusions thereof. The results herein suggest that nano-structured collagen-hydroxyapatite layers impregnated with vancomycin following cross-linking provide suitable candidates for use as local drug delivery carriers.
- MeSH
- Anti-Bacterial Agents * administration & dosage chemistry MeSH
- Durapatite * administration & dosage chemistry MeSH
- Collagen * administration & dosage chemistry MeSH
- Plasma chemistry MeSH
- Drug Delivery Systems * MeSH
- Humans MeSH
- Cell Line, Tumor MeSH
- Nanostructures administration & dosage chemistry MeSH
- Osteoblasts drug effects MeSH
- Staphylococcus aureus drug effects MeSH
- Staphylococcus epidermidis drug effects MeSH
- Vancomycin * administration & dosage chemistry MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
External fixators of serious fractures could be an attractive substrate on which microorganisms can accumulate. Therefore, this study aimed to develop a suitable method for enabling the simulation of a real situation when osteosynthetic fixation material is open for the potential threat of bacterial attack. Agar-based media represented human tissue, and the metallic pin characterized the screw in the fixation. Various types of agar, supplements, and contamination strategy by Staphylococcus aureus were tested. The influence of the initial bacterial concentration was also examined. Surfaces were observed by scanning electron microscopy (SEM), and all results were compared. Brain Heart Infusion Agar with the Egg Yolk Tellurite Emulsion was established in a transparent test tube as a suitable system for enabling the good interpretability of bacterial contamination in the pin's surroundings. Pin contamination has been found to be an appropriate approach for testing microbial growth, rather than agar surface contamination, which distorted obtained results. A lower initial colony forming units (CFU) provided better clarity of the test. SEM observation of the pin surface was comparable with the visual evaluations in the test tubes. Results were assembled for positive and negative control samples as well. Screening method for the most common bacteria S. aureus has been standardized and developed. This experimental setup could also be a useful tool for surface modification with antibacterial properties testing.
- MeSH
- Anti-Bacterial Agents pharmacology MeSH
- Biofilms drug effects growth & development MeSH
- External Fixators microbiology MeSH
- Equipment Contamination * MeSH
- Culture Media MeSH
- Humans MeSH
- Microscopy, Electron, Scanning MeSH
- Colony Count, Microbial MeSH
- Staphylococcus aureus drug effects growth & development ultrastructure MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Stable antimicrobial nanofibrous membrane for air filtration based on polyamide 6 (hereafter PA6) modified by 1-dodecyltrimethylammonium bromide (DTAB) has been prepared by electrospinning using one-step technology, i.e. with modifying antimicrobial agent dissolved in spinning solution. Stability of antibacterial membrane function has been tested by air-blowing test to prove the permanency of chemical composition and antibacterial activity. X-ray diffraction, high-resolution scanning electron microscopy (HRSEM) revealed the effect of modifying agent on structure and morphology of PA6 nanofibres. X-ray photoelectron spectroscopy, electrokinetic analysis and antibacterial tests proved the stability of chemical composition and antibacterial activity after air-blowing tests. Special air-blowing device has been constructed for this purpose. The results prove the applicability so prepared membrane for a long-term air-conditioning.
Úvod: Reimplantace močovodu (ureterocystoneoanastomóza = UCNA) je výkonem prováděným z indikací striktur močovodu různé etiologie (následkem iatrogenního působení, endometriózy, poradiační apod.), píštělí močovodu do jiných orgánů, případně v souvislosti s poraněním ureteru. Existuje celá řada modifikací, které lze provádět otevřeným nebo minimálně invazivní přístupem (laparoskopicky nebo s robotickou asistencí). Minimálně invazivní přístup umožňuje v řadě případů dosáhnout dobrého výsledku se sníženou perioperační zátěží. Cíl: Prezentace možností minimálně invazivní UCNA na souboru deseti pacientů (11 ureterálních jednotek). Metody: Laparoskopickou UCNA provádíme transperitoneálně ze čtyř nebo pěti portů (2x10mm a 2-3x5mm) ve Trendelenburgově poloze. Iniciálně je močovod identifikován dostatečně vysoko v místě, kde je nepostižen a optimálně mimo adhezivní proces. Po jeho obejití a zavěšení na hadičku k minimalizaci traumatizace při manipulaci je provedena disekce do nejnižšího možného místa, kde je stále dostatečný průměr a zde je přerušen. V závislosti na kalibru močovodu, typu postižení a délce chybějícího úseku k měchýři je zvolena reimplantace přímá bez nebo s antirefluxní modifikací (extravezikálně či intravezikálně) nebo případně je využit závěs měchýře k m. psoas (tj. psoas hitch) nebo je vytvořen Boariho lalok k překlenutí delšího defektu. Sutura močovodu k měchýři je prováděna vstřebatelným vláknem 4/0 (lze pokračovací či jednotlivé stehy), přičemž lze přidat i "kotevní" stehy do obou pólů anastomózy nebo k extravezikálnímu ukotvení stěny močovodu k měchýři z materiálu silnějšího. Během výkonu je vždy provedeno zajištění stentem na dobu 4-8 týdnů. Měchýřový katétr je ponechán 10-14 dní po výkonu. Délka výkonu je variabilní, protože závisí na zvoleném typu UCNA. Výkony trvaly od 180 do 450 minut (nejdelší byl oboustranný výkon na močovodech - psoas hicth dx a Boariho lalok sin + řešení hluboké endometriózy pánve). Výsledky: V období od 4/2013 do 12/2016 bylo operováno celkem deset pacientů - osm žen a dva muži. Výkon byl prováděn na 11 ureterálních jednotkách (tj. 1x bilaterální výkon). Indikace výkonu: šest pacientek hluboká pánevní endometrióza (DIE = deep infiltrating endometriosis) se strikturou močovodu a zachovalou funkcí ledviny (4x vlevo, 1x vpravo, 1x oboustranně), dvě pacientky striktura močovodu v důsledku přechozí hysterektomie, jeden muž striktura distálního močovodu po opakovaných transuretrálních resekcích ústí při anamnéze nádoru měchýře (v době operace beznádorový interval >3 roky), jeden muž s perioperačním poraněním močovodu během laparoskopické radikální prostatektomie a řešením v jedné době. Celkem bylo provedeno devět extravezikálních UCNA (3x přímá, 6x s psoas hitch), jeden Boariho lalok (jako součást oboustranného výkonu na močovodu) a 1x intravezikální antirefluxní modifikace Politano‑Laedbetterovy reimplantace. Perioperační průběh byl vždy nekomplikovaný. Operace pro DIE pánve byly vždy prováděny v týmu gynekolog a urolog se současným ošetřením pánevní endometriózy a řešením postižení močovodu v jedné době. Operace UCNA po poranění močovodu byly provedeny s odstupem tří měsíců. U jedné pacientky po oboustranné UCNA pro DIE byla pět týdnů po výkonu (dva týdny po odstranění močového katétru) zjištěna volná tekutina v dutině břišní (zvětšení obvodu břicha, ale afebrilní, močící, aperitoneální, pasáž +), nicméně provedená CT urografie a cystografie neprokázala žádný únik mimo močové cesty. Přesto stav zareagoval na zavedení PMK s kompletní úpravou po dalších dvou týdnech. U jedné pacientky po oboustranném výkonu pro DIE (vlevo ureterografie a vpravo UCNA s psoas hitch) došlo pooperačně k manifestaci polohového traumatu n. peroneus vpravo a hluboké flebotrombóze s pozdější kompletní neurologickou a cévní úpravou po odpovídající terapii. U jedné pacientky s přímou extravezikální UCNA pro DIE došlo po extrakci katétru k bolestem na podkladě vezikoureterálního refluxu, bez infekce, přičemž se stav zcela upravil během čtyř týdnů s anticholinergní terapií. U jedné pacientky po UCNA pro DIE došlo po odstranění katétru (za dva týdny) k febrilní uroinfekci i přes zajišťovací léčbu, byla nutná rehospitalizace a cílená antibiotická terapie. Všechny uvedené komplikace spadaly do stupně 2 Clavien‑Dindovy klasifikace. U všech pacientů je po extrakci stentu anatomický i funkční výsledek bez známek hydronefrózy, bez bolesti či klinických projevů refluxu nebo infekce. Závěr: Minimálně invazivní UCNA je výkon, který lze provést v řadě modifikací podle typu postižení močovodu a délky postiženého/chybějícího úseku. Lze jej kombinovat v jedné době s jiným typem výkonu (např. ošetření DIE pánve nebo jako pokračování jiného výkonu, který vedl k poranění močovodu), pak se ale jedná o výkony delšího trvání. Vzniklé komplikace dosahovaly maximálně stupně 2 dle Claviena‑Dinda. Funkční i anatomický výsledek je vyhovující.
Introduction: Indications for ureteral reimplantation (ureterocystoneostomy = UCN) include ureteric strictures of various etiology (due to iatrogenic injuries, endometriosis, post radiotherapy etc.), fistulas from ureter into various organs or ureteral trauma. There are a number of modifications, which can be carried out via open or minimally invasive approach (laparoscopic or robot-assisted). Minimally invasive (MI) approach can achieve a good result with decreased perioperative morbidity in many cases. Aim: Presentation of modification of minimally invasive UCN on a cohort of 10 patients (11 ureteral units). Methods: We perform laparoscopic UCN transperitoneally using 4-5 ports (2x 10mm, 2-3x 5mm) in Trendelenburg position. Initially, the ureter is identified relatively higher in the unaffected area and ideally away from the adhesive process. Following ureteral circumferential dissection a loop is placed around it to minimize traumatization by manipulation and dissection is carried out downwards to the lowermost possible level with sufficient ureteral caliber and here it is divided. Based on ureteral caliber, type of process and length of missing segment to urinary bladder, a type UCN is selected - direct without or with antireflux modification (extravesical or intravesical technique) or psoas hitch or Boari flap in order to bridge a longer defect. Ureter to bladder suturing is done using absorbable 4/0 suture (either continuous or interrupted), with possible "anchoring" sutures using stronger material placed into both poles of the anastomosis. Stenting is performed during intervention and it is left in situ for 4-8 weeks. Bladder catheter is kept for 10-14 days. Length of surgery varies as it depends on the selected UCN modification. Our procedures were between 180 and 1450 minutes (the longest was bilateral UCN with right psoas hitch and left Boari flap including management of underlying deep pelvic endometriosis). Results: We operated on 10 patients (8 women and 2 men) between 4/2013 and 12/2016. We performed intervention on 11 ureteral units (i.e. 1 bilateral case). Indications included: 6 women with pelvic deep infiltrating endometriosis (DIE) and ureteric stricture with good renal function (4x left, 1x right, 1 bilateral), 2 women with ureteric strictures following previous hysterectomy, 1 man with distal ureteric stricture following repeated transurethral bladder resection in the area of ureteral orifice (at the time of surgery tumor free for more than 3 years), 1 man with intraoperatively recognized ureteral transection during laparoscopic radical prostatectomy (managed simultaneously). There were 9 extravesical UCN (direct 3x, with psoas hitch 6x), 1 Boari flap (during the bilateral case) and 1 intravesical antireflux Politano-Laedbetter UCN modification. Perioperative course was always uneventful. Intervention due to pelvic DIE were always carried out as one-stage procedure by team of gynecologist and urologist with concurrent complete management of pelvic DIE and ureteral involvement. UCN as management of strictures from previous procedures were all carried out after a 3-month interval. In one patient after bilateral UCN for DIE free intrabdominal fluid was diagnosed (complaining on increased waist circumference, but afebrile, voiding normally, aperitoneal, normal bowel motions), however immediate CT urography and cystography failed to detect any urinary tract leak. Complete resolution occurred after bladder catheter insertion for 2 more weeks. In one patient following bilateral ureteral management (ureteroureteroanastomosis left and UCN with psoas hitch right) positional trauma affecting n. peroneus and deep vein thrombosis occurred, with complete neurologic and vascular resolution following appropriate therapy. One patient following direct extravesical UCN for DIE suffered from symptoms of vesicoureteral reflux after bladder catheter removal, without any infection, and this resolved after 4 weeks of anticholinergic therapy. One patient after UCN for DIE had febrile urinary tract infection following bladder catheter removal 2 weeks after surgery despite antimicrobial prophylaxis, with readmission and antibiotic therapy. All postoperative complications (within 90 days) were Clavien-Dindo grade 2. After stent removal, all patients have a good anatomic and functional result without symptoms of infection or reflux and hydronephrosis. Conclusions: Minimally invasive UCN is a procedure with multiple modifications depending on the type of ureteral involvement and length of affected/missing segment. It can be combined as one-stage procedure together with other intervention (such as management of pelvic DIE or if a different operation results in ureteral injury), that however lead to longer duration of surgery. Recognized complications were maximally Clavien-Dindo grade 2. Functional and anatomical results were satisfactory.
- Keywords
- UCNA (ureterocystoneoanastomóza),
- MeSH
- Endometriosis surgery MeSH
- Laparoscopy methods MeSH
- Humans MeSH
- Practice Guidelines as Topic MeSH
- Ureter * surgery pathology MeSH
- Urologic Surgical Procedures * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
