Efficacy of antibacterial bioactive glass S53P4 against S. aureus biofilms grown on titanium discs in vitro

We evaluated the effectiveness of different sizes of bioactive glass S53P4 against Staphylococcus aureus biofilms grown on metal discs in vitro. S. aureus biofilms were cultivated on titanium discs. BAG‐S53P4 (0.5–0.8 mm and <45 µm) were placed in contact with the discs containing biofilms. Glass beads (0.5 mm) were used as a control. After each interval, the pH from each sample was measured. Colony forming units were counted for the biofilm recovery verification. In parallel, we tested the activity of bioactive glass against S. aureus planktonic cells. We found that BAG‐S53P4 can suppress S. aureus biofilm formation on titanium discs in vitro. The suppression rate of biofilm cells by BAG‐S53P4 <45 µm was significantly higher than by BAG‐S53P4 0.5–0.8 mm. BAG‐S53P4 has a clear growth‐inhibitory effect on S. aureus biofilms. BAG‐S53P4 <45 µm is more efficient against biofilm growth in vitro comparing with BAG‐S53P4 0.5–0.8 mm. Bioactive glass S53P4 has potential to be used as bone substitute for the resolution of infection complications in joint replacement surgeries and treatment of chronic osteomyelitis. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:175–177, 2014.     

Prevention of bacterial leakage through instrumented root canals by bioactive glass S53P4 and calcium hydroxide suspensions in vitro.

OBJECTIVE: The capacities of bioactive glass S53P4 and calcium hydroxide suspensions to prevent microbial leakage through instrumented root canals were compared. STUDY DESIGN: Root canals of caries-free extracted human mandibular premolars were instrumented and randomly filled with calcium hydroxide or S53P4 (n = 14 each). Crowns were exposed to Enterococcus faecalis ATCC 29212 suspensions in a test setup with 2 broth chambers, and leakage was checked daily. Event times were compared using log rank test. After 50 days, teeth were fractured and inspected in a scanning electron microscope (SEM). RESULTS: Calcium hydroxide prevented leakage significantly better than S53P4 (P < .05). Estimated mean days to leakage were 26 for calcium hydroxide and 4 days for S53P4. The SEM observations revealed substantial calcification of the glass material in the root canal but also gaps containing clusters of coccoidal bacteria. CONCLUSION: The bioactive glass material under investigation could not prevent contamination of instrumented root canals.     

Bioactive glass S53P4 as bone graft substitute in treatment of osteomyelitis

Bioactive glass (BAG)-S53P4 is an osteoconductive bone substitute with proven antibacterial and bone bonding properties. In a multicentre study 11 patients with verified chronic osteomyelitis in the lower extremity and the spine were treated with BAG-S53P4 as a bone substitute. The cavitary bone defect and the surrounding of a spinal implant were filled with BAG-S53P4. The most common pathogen causing the infection was Staphylococcus aureus. The mean follow-up was 24 months (range 10–38). BAG-S53P4 was well tolerated. Nine patients healed without complications. One patient who achieved good bone formation sustained a superficial wound infection due to vascular problems in the muscle flap, and one patient had an infection due to a deep haematoma. This study shows that BAG-S53P4 is a good and well-tolerated bone substitute, and can be used in treatment of osteomyelitis with good primary results.     

In vitro antibacterial efficacy of endodontic irrigants against Enterococcus faecalis.

OBJECTIVE: The objective of this study was to compare the in vitro antimicrobial activity of 2% chlorhexidine gel against Enterococcus faecalis with sodium hypochlorite in 2 different concentrations (1.5% and 5.25%). STUDY DESIGN: Eighty human lower premolars with single root canals were prepared, autoclaved, and infected for 7 days with E. faecalis monocultures. The roots were then separated into 5 experimental groups according to the irrigant solution used during the standardized preparation. To assess the antimicrobial action of the irrigant solutions, 3 microbial samples were taken: S1--initial (before the biomechanical preparation), S2--posttreatment (immediately after the biomechanical preparation), and S3--final (7 days after the biomechanical preparation). The microbiological samples were plated to count the colony-forming units (CFU). RESULTS: The 2% chlorhexidine gel and 5.25% sodium hypochlorite significantly reduced the E. faecalis CFU in the posttreatment and final microbiological samples. The 1.5% sodium hypochlorite also reduced the E. faecalis CFU immediately after the root canal instrumentation, but the E. faecalis CFU increased in the final sample showing no statistical difference from the control group. CONCLUSION: The 2% chlorhexidine gluconate gel and 5.25% sodium hypochlorite were effective in eliminating E. faecalis even 7 days after the instrumentation; moreover, the higher the concentration of sodium hypochlorite the better its antimicrobial action.     

In vitro assessment of the effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine against Enterococcus faecalis and Candida albicans.

OBJECTIVE: The purpose of this study was to compare the effectiveness of various medicaments, including Ca(OH)2/2% chlorhexidine, 2% chlorhexidine gel, and Ca(OH)2 alone, against Enterococcus faecalis and Candid albicans in vitro. STUDY DESIGN: Eighty extracted single-rooted human maxillary teeth were used. After removing the crown, each root was instrumented up to size 50 by using a conventional technique. The root canal was irrigated with ethylenediamine tetra-acetic acid (EDTA) solution to remove smear layer. Then, roots were infected with E faecalis and C albicans. Subsequently, the roots were divided into 4 treatment groups: group 1 was treated with calcium powder hydroxide in distilled water, group 2 was treated with calcium hydroxide powder in 2% chlorhexidine, group 3 was treated with 2% chlorhexidine gel, and group 4 was treated with 0.9% sterile saline serving as negative control. Microbial samples were taken after 7, 15, and 30 days. After incubation, dentine chips were obtained form each root canal and examined microbiologically. The microbiological samples were plated to count colony-forming units in per milligram of dentin. RESULTS: The results showed that the 2% chlorhexidine gel was significantly more effective than calcium hydroxide with 2% chlorhexidine, calcium hydroxide, and control saline solution (P < .05). CONCLUSION: Under the conditions of this study, 2% chlorhexidine gel is effective in the elimination of E faecalis and C albicans from the root canal system. However, to support this in vitro observation, further in vivo studies are needed.     

Bioactive glass S53P4 and autograft bone in treatment of depressed tibial plateau fractures - a prospective randomized 11-year follow-up

The clinical and radiological outcomes of bioactive glass (BAG)-S53P4 and autograft bone (AB) used as bone-graft substitutes in depressed tibial plateau fractures were evaluated in a prospective randomized 11-year follow-up study. All patients (n = 29) had sustained tibial plateau fractures with a joint-line depression of >3 mm. Fifteen patients (5 patients the BAG group, 10 patients in the AB group) participated in this long-term follow-up. X-rays were taken preoperatively, postoperatively, and at the long-term follow-up, and computed tomography (CT) scans were made at the long-term follow-up for evaluation of the bone substitute, osteoarthritis, the tibial-femoral angle, and deviation of mechanical axes. No material-dependent adverse effects were seen in any patient. The means of the articular surface depression on X-rays at the long-term follow-up were 1.4 mm (range: 0-2 mm) in the BAG group and 1.4 mm (range: 0-4 mm) in the AB group, and on CT scans the means were 2.2 mm (range: 2-3 mm), and 2.1 mm (range: 0-3), respectively. No significant difference in the tibial-femoral angle or deviation of mechanical axes was observed between the two groups. BAG-S53P4 can be used as a bone substitute in depressed lateral tibial plateau fractures with good functional and radiological long-term results.     

In vitro assessment of the immediate and prolonged antimicrobial action of chlorhexidine gel as an endodontic irrigant against Enterococcus faecalis.

OBJECTIVE: The aim of this study was to assess in vitro the antimicrobial activity of 2% chlorhexidine gel against Enterococcus faecalis , comparing it to other endodontic irrigants (2% chlorhexidine liquid and 5.25% sodium hypochlorite). STUDY DESIGN: Eighty roots of human mandibular premolars were prepared by serial instrumentation technique, autoclaved, and contaminated for 7 days with E faecalis monocultures. The roots were then divided into 5 groups according to the irrigant substance used during the standardized biomechanical preparation. In order to evaluate the antimicrobial action of the irrigant substances, 3 microbial samples were taken: initial (before the biomechanical preparation); post-treatment (immediately after the biomechanical preparation), and final (7 days after the biomechanical preparation). The microbiological samples were plated to count the colony-forming units (CFU). RESULTS: The 2% chlorhexidine gel and 2% chlorhexidine liquid significantly reduced the E faecalis CFU in the post-treatment and final microbiological samples. The 5.25% sodium hypochlorite also reduced the E faecalis CFU immediately after the root canal instrumentation, but it was not able to keep the root canal free of detectable E faecalis in the final sample. CONCLUSIONS: The 2% chlorhexidine gluconate (gel and liquid) antimicrobial ability was more effective than 5.25% sodium hypochlorite in keeping low CFU of E faecalis for 7 days after the biomechanical preparation.     

Antimicrobial effect, in vitro, of gutta-percha points containing root canal medications against yeasts and Enterococcus faecalis.

OBJECTIVE: The objective of this study was to determine the in vitro susceptibility of Enterococcus faecalis and the most prevalent Candida species as therapy-resistant microorganisms to gutta-percha points containing root canal medications. STUDY DESIGN: Gutta-percha points containing calcium hydroxide (Calcium Hydroxide Plus Points), chlorhexidine diacetate (Activ Points), or calcium hydroxide-chlorhexidine combinations (CHX/Ca Combi Points) were tested for their ability to inhibit growth of pure cultures of Candida albicans, Candida glabrata, Candida parapsilosis, Candida krusei, Candida tropicalis, Saccharomyces cerevisiae, and Enterococcus faecalis. Approximately 2 x 10(7) microorganisms per assay were suspended in diluted human serum and co-incubated with the gutta-percha points placed in Eppendorf tubes in an incubator for up to 2 weeks. A tube was removed at 1, 2, 3, 4, 7, and 14 days, and then opened and microorganism suspensions were serially diluted in a sterile 0.9% NaCl solution. Aliquots of the dilution steps were streaked onto solid medium. After incubating the plates in an incubator at 37 +/- 1 degrees C for 48 hours, CFU numbers per milliliter of suspension were calculated. RESULTS: Calcium Hydroxide Plus Points or Activ Points did not exhibit sufficient antimicrobial or anticandidal activity for Enterococcus faecalis, Candida albicans, C. glabrata, C. parapsilosis, C. krusei, or C. tropicalis within 14 days. Only Saccharomyces cerevisiae was susceptible to the calcium hydroxide or chlorhexidine diacetate containing gutta percha points. CHX/Ca Combi Points killed C. albicans, C. glabrata, C. krusei, C. tropicalis, and S. cerevisiae completely. However, E. faecalis and C. parapsilosis were resistant to CHX/Ca Combi points within 14 days. CONCLUSION: The results show the gutta percha points containing a mixture of calcium hydroxide and chlorhexidine diacetate have efficacies superior to calcium hydroxide or chlorhexidine diacetate alone against some microorganisms except E. faecalis and C. parapsilosis.     

Efficacy and Safety of Bioactive Glass S53P4 as a Treatment for Diabetic Foot Osteomyelitis

Osteomyelitis represents a challenging condition in the diabetic foot with an associated high risk of major amputation. S53P4 Bioactive Glass (BG) has bacterial inhibiting properties on the market and indicated to be used in osteomyelitis. The objective of the study was to test the efficacy and safety of BG in treating diabetic foot osteomyelitis. This was an observational, retrospective, single-centre study involving subjects with diabetes affected by osteomyelitis of the foot who underwent surgical debridement from 01/2016 to 10/2018. Overall, 44 diabetic patients (14 [31.8%] female, aged 68.0 ± 10.2 years, diabetes duration 26.8 ± 11.9 years) were studied: 22 (50%) treated with surgical debridement and a local application of BG; 22 (50%) treated by means of surgical debridement. The primary outcome was the osteomyelitis resolution. Revascularization was performed before surgical procedure in 31 (70.5%) of patients. Systemic antibiotics were used in both groups. The osteomyelitis resolution rate was significantly higher in subjects treated with BG than in subjects treated with traditional procedure (18 [90%] vs 13 [61.9%], respectively p = .03). The odds of BG to reach osteomyelitis resolution was 5.54 times greater than for traditional treatment (odds ratio 5.54, 95% confidence interval 1.10-30.5). The use of BG was associated with an 81% lower probability to need additional antibiotic therapy compared to subjects treated with traditional procedure (odds ratio 0.19, 95% confidence interval 0.04-0.87). The debridement of osteomyelitis followed by application of BG could be an effective and safe option in the treatment of osteomyelitis of the diabetic foot.     

Efficacy of tigecycline and rifampin alone and in combination against Enterococcus faecalis biofilm infection in a rat model of ureteral stent

BackgroundPreoperative risk stratification for noncardiac thoracic surgery focuses on predicting postoperative lung capacity and cardiac risk. We hypothesized that preoperative functional status may be a predictor of morbidity and mortality after thoracic surgery.MethodsThe National Surgical Quality Improvement Program Participant Use Files from 2005 to 2009 were accessed, and current procedural terminology codes for procedures involving the lung and pleura were used to identify thoracic surgery patients. Patients were grouped by independent or dependent preoperative functional status. Risks of infectious and noninfectious complications were evaluated. Chi-square, Fisher exact, and multivariate analyses with stepwise logistic regression were used. This study was approved by the Institutional Review Board.ResultsOf 6,373 patients, 812 had a preoperative dependent functional status. Dependent patients had significantly higher rates of infection, other adverse events, and mortality. They were 9.3 times more likely (odds ratio [OR] 9.3) to have prolonged ventilation (P < 0.001) and 3.1 times more likely to be reintubated (P < 0.001). Postoperative pneumonia occurred in 10% (OR 2.7, P < 0.001). Postoperative mortality was 7.7 times higher (P < 0.001). Preoperative functional status, wound classification 3, and emergency procedures were independent predictors of both morbidity and mortality. Performing a thoracotomy was an independent risk factor for postoperative morbidity but not mortality (P < 0.001, OR 2 versus P = 0.415, OR 1.1).ConclusionsThoracic surgery patients, classified as functionally dependent preoperatively are at high risk for major morbidity and mortality. Although a limited observational study, results show that functional status is an essential component of preoperative assessment for thoracic surgery patients.     

Septic necrosis of the odontoid apophysis and cervical spondylodiscitis from Enterococcus faecalis endocarditis: a first report

We describe a 75-year-old male patient who developed a general syndrome, with a fever of 39 degrees C, weight loss, and cervical pain, during the month following a urological procedure. The presence of positive blood cultures for Enterococcus faecalis, aortic vegetations, and severe aortic regurgitation observed with echocardiogram confirmed the diagnosis of infective endocarditis (IE). Magnetic resonance imaging of the spinal cord showed significant erosion and irregularities of the odontoid apophysis, with hyperintensity of bone marrow in T2-weighted images because of edema and inflammation. These findings suggested an infective necrosis of the odontoid apophysis. Despite the common occurrence of rheumatologic manifestations in IE, with prevalence rates of 25% to 44%, spondylodiscitis is rarely observed (5%-13%). The lumbar region is the most commonly involved. We found only one other reported case of cervical spondylodiscitis. The case we describe is the first report of septic necrosis of the odontoid apophysis associated with IE.     

转移相关基因nm23和P53及S100A4在晚期胃癌中的表达及与侵袭转移的相关性研究

目的探讨转移相关蛋白（nm23和P53及S100A4）在晚期胃癌转移发展过程中的意义。方法应用组织芯片和免疫组织化学方法研究nm23、P53和S100A4在74例胃癌患者的癌、癌旁、淋巴结转移、远处转移（肝脏、胰腺、卵巢等）组织中的表达。结果同癌旁组织相比，癌组织中P53和S100A4表达明显升高（P〈0．01），而nm23的表达明显降低（P〈0．05）；同癌组织相比，淋巴结中nm23的表达明显降低（P〈0．05）。远处转移组织S100A4表达明显升高（P〈0．01）。3者的阳性表达与胃癌的部分恶性生物学行为有关。癌组织中nm23^＋／P53^＋、P53^＋／S100A4^＋和nm23^＋／S100A4^＋的基因表型比例分别为48例（64．9％）、50例（67．6％）和39例（52．7％），其中P53^＋／S100A4^＋、nm23^＋／S100A4^＋和nm23^＋／P53^＋／S100A4^＋均与胃癌的高转移潜能相关。结论nm23和S100A4在肿瘤转移中发挥了重要作用；联合检测nm23、P53和S100A4的表达可用于评定胃癌的转移潜能。     

生存素反义寡核苷酸联合 P53基因抑制胃癌细胞的生长作用

目的 研究生存素（survivin）反义寡核苷酸联合抑癌基因P53对人胃癌细胞系HS-746T的抑制作用及机制。方法 用P53基因和设计合成的survivin反义寡核苷酸（ASODN）对胃癌细胞系HS-746T进行处理，分空白对照组、反义survivin转染组，P53基因组，反义survivin加P53共转染组。采用细胞计数和四甲基偶氮唑蓝（MTT）法检测细胞增殖能力及细胞生长速度，用RT-PCR技术和Western印迹法分析survivin mRNA及蛋白质的表达情况，末端原位标记染色法（TUNEL）分析细胞凋亡指数。结果 不同时间反义survivin转染组、P53基因组和共转染组均对胃癌细胞的生长有抑制作用，且能够下凋胃癌细胞survivin mRNA和蛋白质的表达，共转染组较单独用药组效应明显增强，共转染组胃癌细胞凋亡指数高于另外两组。结论 Survivin反义寡核苷酸联合P53基因抑制人胃癌细胞的生长及诱导凋亡的作用大于单独应用一种药物。     

The effectiveness of adjustable gastric banding: a retrospective 6-year U.S. follow-up study

Background  

This study aimed to assess the efficacy of laparoscopic adjustable gastric banding (LAGB) during a 6-year follow-up period.