Are late hernia mesh complications linked to Staphylococci biofilms?

PURPOSE: The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection. METHODS: In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR. RESULTS: Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques. CONCLUSION: Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.

Variation of ethinylestradiol blood levels among healthy women using oral contraceptives.

Data concerning ethinylestradiol (EE) blood levels among 93 healthy women using oral contraceptives are presented. Seventy-two per cent of the observed variation in EE blood levels was unexplainable on the basis of time since ingestion of the last oral contraceptive, day of menstrual cycle, race, age, weight, height, blood pressure, cigarette consumption, alcohol consumption, diurnal variation, or lifetime use of oral contraceptives.

PIP: This 2-fold investigation studied 1) the extent to which women vary in blood levels of ethinylestradiol (EE) after ingesting oral contraceptives (OCs) containing similar amounts of EE or mestranol (ME), which is metabolized to EE; and 2) whatever variations might be accountable on the basis of physical, behavioral, or other characteristics. 93 healthy OC users were given either OCs with 50 mcg of ME (84 subjects) of 50 mcg of EE (9 subjects). Linear regression was used to determine relevance of variation in EE blood levels based on hours since pill ingestion, day of menstrual cycle, or any other variables. Hours since OC showed the strongest relationship to log EE, accounting for 25% of the variation. Another 3% could be accounted for by day of menstrual cycle. The remaining 72% of observed variation in EE levels could not be explained in terms of time since ingestion of last OC, day of menstrual cycle, race, age, weight, height, or use-duration of OCs.

Blood levels of ethynylestradiol, caffeine, aldosterone and desoxycorticosterone in hypertensive oral contraceptive users.

Twenty normotensive and ten hypertensive black women taking oral contraceptive (OC) were studied. Age, body weight, family medical history of hypertension, length of OC use, and type of OC were comparable. At midcycle approximately 10-12 hours following OC intake, blood was drawn and the plasma was used to determine ethynylestradiol (EE2), caffeine, aldosterone (Aldo) and desoxycorticosterone (DOC) levels. The results showed that in hypertensive OC users, EE2 and caffeine levels were significantly higher (P less than .01) compared to normotensive OC users. While no significant differences were found in Aldo and DOC levels between hypertensive and normotensive OC users, OC users had higher levels of Aldo (P less than .01) compared to non-OC users.

Immunopathology of Marek's disease in quails: presence of antinuclear antibody and immune complex.

Antinuclear antibody (ANA), a marker for autoimmune reactions, was detected in the sera of quails with Marek's disease (MD). The autoantibody was detected 3 weeks after infection in quails infected with chicken Marek's disease virus and 4 weeks after infection in quails infected with quail Marek's disease virus. The ANA titers were low and ranged from 10 to 40. A speckled type of nuclear fluorescence was the characteristic staining feature. In addition to the presence of ANA, immune complexes (IC) were also detected in the kidney glomeruli of quail infected with Marek's disease virus. Initially about 25-30% of the glomeruli in the kidneys of infected quails had IC deposits. In subsequent periods, the amount of IC deposit and the number of glomeruli showing IC also increased considerably. The findings of the present study suggested autoimmunity may play a pathogenic role in MD.

Immune complex-mediated glomerulopathy in Marek's disease.

Chickens infected with Marek's disease (MD) virus developed immune complex (IC)-mediated glomerulopathy. Fluorescent antibody staining technique using antichicken globulin and antichicken complement was used to demonstrate IC in the kidney glomeruli. During the initial stages of MDV infection, IC deposits were seen on the glomerular basement membrane, but subsequently the entire glomerulus was involved. Mesangial cells also had IC deposits. Chicken complement was demonstrated in the glomeruli which had IC deposits. The number of glomeruli with IC deposition was higher in tumor-bearing birds than in non-tumor-bearing birds. Histologically, kidney lesion were characterized by thickening of basement membrane and proliferation of mesangial cells. It is suggested that IC-mediated glomerulopathy might be one of the major causes of death in MD.

High-fiber diet in the treatment of obesity and hypercholesterolemia.

Nine obese patients weighing 20% or more above the desired body weight with ages ranging from 38 to 73 years participated in a study in which they were given Meal Exchange for 1 to 8 months. Meal Exchange is a high-fiber (14.68 gm/2 tbsp) food product composed of nuts, nonfat milk, whole grains, and lactase. Total weight loss and cholesterol levels were recorded. There was significant weight loss and drop in blood cholesterol levels.

Management of obesity in low-income African Americans.

The Bariatrics Clinic at Howard University Hospital was initiated to help low-income African-American adults with low literacy skills in obesity control. Fourteen African-American women and two men participated in the study. Essential components of the treatment included nutrition education, exercise, and behavior modification related to food intake. The nutrition education component involved teaching nutritional needs, taking into account low literacy skills, low economic status, and individual food preferences. A realistic diet plan was based on individual needs, economic status, availability of food, likes and dislikes, lifestyle, and family dynamics. On average, patients lost 2 lb a week on this program. On average, a 14-lb weight loss occurred in seven weeks. There has been a 10% dropout from this program as opposed to drop out rates of 40% to 50% with other treatments. The main reasons for the success of this program is that it is individualized and is sensitive to food preferences.

Nutritional assessment of low-income elderly African-American population.

The purpose of this study was to perform a nutritional assessment of low-income, elderly African-American subjects, to develop appropriate nutritional intervention program suitable for their needs and taste to ensure maximum compliance. Twenty-three subjects (18 women and 5 men) aged 60 to 82 years participated in the study. A majority of the subjects had an income of $5,000 to $10,000/year and an education level below junior high school. Eighteen subjects had hypertension and eight of those also had diabetes mellitus. Weights ranged from 131 to 265 pounds, and blood cholesterol level varied from 200 to 288 mg/dL. Their diets were high in sodium and fat and low in fresh fruits and vegetables. Based on this preliminary information, we have developed an instrument to assess the nutritional knowledge of this low-income elderly African-American population and a nutrition education program. After 6 months, nutritional assessment will be performed again. This information will aid us in developing nutrition education modules for the low-income elderly African-American population in the United States.

Management of obesity in black females in a community model clinic: A preliminary study.

During a three-month period, March-May 1978, 23 black females were accepted as patients in the obesity program at the model office of the Department of Community Health and Family Practice, College of Medicine, Howard University.An aggregate of 55 visits made by these patients was recorded for the same period.The mean age of the patients was 38.3 years (SD:13.67), and half of the patients were below 40. Nearly 70 percent had a history of obesity in either one or both parents. More than one half had had high blood pressure and 70 percent of the patients had attempted dieting previously. Common snacks taken by the patients were carbohydrate-rich foods.Based on previous medical and dietary history and behavior patterns related to food intake, the patients were prescribed low-calorie or modified high-protein diets. Each patient at the clinic had a program devised individually for her. A team consisting of a physician, nutritionist, and health educator looked for patterns of behavior causing patients to overeat.The mean initial weight of all patients was 218 lb at registration and the weight after seven weeks of follow-up was 213.8 lb.

Effect of meal-feeding on the daily variations of insulin, glucose, and NADP-linked dehydrogenases in rats.

Normal and adrenalectomized rats were either ad libitum fed or meal-fed a 66.5% glucose diet for 1 to 3 weeks. Ad libitum-fed rats exhibited synchronized daily rhythms in the levels of immunoreactive insulin, glucose, hepatic glucose-6-phosphate dehydrogenase, and malic enzyme activities. These rhythms were shifted late-morning 2-hour feeding period. The rhythms of adrenalectomized ad libitum-fed rats were different from those for nonadrenalectomized rats. These results indicate that differences between ad libitum- and meal-fed animals may be attributable to the timing of food intake with respect to the timing of observation rather than to meal-feeding alone. It is further concluded that the adrenals play a role in the maintenance of these rhythms.

Effect of pancreatectomy or adrenalectomy on the responses of rats to meal-feeding.

The effects of partial pancreatectomy or adrenalectomy and insulin or corticosterone replacement on the responses of rats to meal-feeding were studied. Partial pancreatectomy lowered glucose-6-phosphate dehydrogenase (G6PD) and malic enzyme (ME) activities and resulted in higher blood glucose levels. Partial pancreatectomy did not affect the ability of the animals to adapt to meal-feeding. Insulin supplementation of the pancreatectomized rats restored G6PD and ME activities to those observed in the intact animals and normalized the blood glucose levels in the ad libitum-fed rats. Adrenalectomy decresed the survival of rats subjected to meal-feeding. Eighty percent of the rats died when meal-fed a high glucose diet. Survival was improved when either a 66.5% starch diet or a 40.5% fat diet was substituted for the 66.5% glucose diet. Adrenalectomized meal-fed animals fed 66.5% glucose had higher G6PD and ME activities and higher liver lipid levels than both the adrenalectomized ad libitum-fed and the sham-operated meal-fed rats. Glucocorticoid supplementation lowered G6PD activity in the adrenalectomized meal-fed rats but had no effect on ME activity or liver lipid. Meal-fed adrenalectomized rats had lower liver and serum cholesterol levels than meal-fed intact rats and ad libitum-fed adrenalectomized rats. These cholesterol levels were increased with glucocorticoid supplementation. It was concluded that adaptation to meal-feeding involves an adrenal response to the periodic absence of dietary energy intake, and that the degree of involvement of this response is determined by the composition of the diet.

Zinc inhibits protein phosphorylation in isolated sperm head membranes in Spisula solidissima.

Zinc, when added to the media in concentrations as low as one micromolar, decreased protein phosphorylation in the isolated sperm head membranes in Spisula solidissima, 70-75%. Other divalent cations barium, strontium, cobalt, and copper, in similar concentrations exerted no effect. Sodium fluoride, a phosphatase inhibitor, had no effect on the zinc induced inhibition on protein phosphorylation and, when zinc was added to the media after the phosphorylation reaction of proteins, the inhibitory effect of zinc was lost. The autoradiography of -32P labeled proteins on SDS gel confirmed the inhibitory effect of zinc on protein phosphorylation. The inhibitory role of zinc on protein phosphorylation in the sperm membranes suggests a physiological role of this cation on membrane activity in the process of fertilization.

Evidence of facilitory effect of growth hormone on tissue vitamin A uptake in rats.

The proposed study was designed to investigate the effect of growth hormone (GH) on liver vitamin A release and uptake at the tissue level. Labeled vitamin A (retinol) was injected in hypophysectomized (hypox) rats, and plasma radioactivity was monitored at intervals for up to 6 hours and at 24 hours following injection. Controls (intact sham-operated) received similar treatment. The results showed that the radioactivity reached its maximum levels in both groups between the third and fourth hours following injection and declined thereafter at different rates in each group. At 24 hours following injection, plasma radioactivity in the intact rats was less than 10% of its maximum levels while in the hypox rats for the same time period it remained at 80--90% of its maximum levels. A single injection of GH at the third hour after injection in the hypox rats decreased significantly (P less than 0.01) plasma radioactivity while radioactivity in the testes and kidneys and in urine collected for the 24 hours increased significantly (P less than 0.01). Hypophysectomy had no effect of vitamin A absorption and liver vitamin A release to the blood. Also, hypophysectomy had no significant effect on plasma and tissue retinol-binding protein levels and its binding capacity to retinol. It is concluded that a facilitory effect of GH at the tissue level may be an important factor in vitamin A metabolism.

The role of diet in prostate cancer.

This is a one-to-one, age- and race-matched case-control study involving 55 histologically confirmed black prostate cancer patients and 55 controls who were seen at three major hospitals in Washington, DC from 1982 to 1984. Personal interviews were conducted to obtain the number of times food items of specified serving size were consumed per week by cases and controls; the subjects were grouped according to the age periods 30-49 and 50 years and older. We then calculated the average daily consumption of each of 18 nutrients per 1,000 calories. There was a significant negative association between linoleic acid (p less than 0.04) for the 50 years and older group, thiamin (p less than 0.05) for those 30-49 years old, riboflavin (p less than 0.03) for the 50 and older group, and iron (p less than 0.05) for those 30-49 years old. The results of this study suggest that the intake of thiamin and iron (in subjects 30-49 years old), linoleic acid and riboflavin (in subjects 50 years and over) could be protective because control subjects consumed more of these nutrients than did the cases.

Nutrition and prostate cancer: a case-control study.

This one-to-one, age- and race-matched case-control study involved 181 histologically confirmed black prostate cancer patients and 181 controls seen at three major hospitals in Washington, DC, during the period 1979-1982. Personal interviews were conducted to obtain the number of times food items of specified serving size were consumed per week by cases and controls during the age periods 30-49 and 50 years and older. Then the average daily consumption of each of 18 nutrients per 1,000 calories was calculated. There was risk enhancement associated with increased intake of proteins, total fat, saturated fat, oleic acid, and vitamin A during the age period 30-49 years. The association was highly significant for vitamin A and approached statistical significance for the other four nutrients. A hypothesis based on disturbance of the zinc-retinol binding protein-vitamin A axis was put forward to explain the relative risk enhancement effect of vitamin A on prostate cancer.