Sustainable Antibacterial and Anti-Inflammatory Silk Suture with Surface Modification of Combined-Therapy Drugs for Surgical Site Infection.

Silk sutures with antibacterial and anti-inflammatory functions were developed for sustained dual-drug delivery to prevent surgical site infections (SSIs). The silk sutures were prepared with core-shell structures braided from degummed silk filaments and then coated with a silk fibroin (SF) layer loaded with berberine (BB) and artemisinin (ART). Both the rapid release of drugs to prevent initial biofilm formation and the following sustained release to maintain effective concentrations for more than 42 days were demonstrated. In vitro assays using human fibroblasts (Hs 865.Sk) demonstrated cell proliferation on the materials, and hemolysis was 2.4 ± 0.8%, lower than that required by ISO 10993-4 standard. The sutures inhibited platelet adhesion and promoted collagen deposition and blood vessel formation. In vivo assessments using Sprague-Dawley (SD) rats indicated that the coating reduced the expression of pro-inflammatory cytokines interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α), shortening the inflammatory period and promoting angiogenesis. The results demonstrated that these new sutures exhibited stable structures, favorable biocompatibility, and sustainable antibacterial and anti-inflammatory functions with potential for surgical applications.

Accelerative effect of topical Zataria multiflora essential oil against infected wound model by modulating inflammation, angiogenesis, and collagen biosynthesis.

CONTEXT: Zataria multiflora Boiss (Lamiaceae) essential oil (ZME) is believed to be a bactericide herbal medicine and might alleviate negative effects of infection. OBJECTIVE: This study evaluates the effects of an ointment prepared from ZME (ZMEO) on infected wounds. MATERIALS AND METHODS: A full-thickness excisional skin wound was surgically created in each mouse and inoculated with 5 × 107 suspension containing Pseudomonas aeruginosa and Staphylococcus aureus. The BALB/c mice (n = 72) were divided into four groups: (1) negative control that received base ointment (NCG), (2) positive control that daily received Mupirocin® (MG), (3) therapeutic ointment containing 2% ZMEO and (4) therapeutic ointment containing 4% ZMEO, for 21 days. Wound contraction, total bacterial count, histopathological parameters, antioxidant activity, qRT-PCR analysis for expression of IL-1ß, TNF-α, VEGF, IGF-1, TGF-ß, IL-10, and FGF-2 mRNA levels were assessed on days 3, 7, and 14 following the wounding. RESULTS: Topical administration of ZMEO significantly decreased the total bacterial count and wound area and also expression of IL-1ß and TNF-α compared to the control groups (p < 0.05) in all days. This could also increase significantly the expression of TGF-ß, IL-10 IGF-1, FGF-2, and VEGF, and also angiogenesis, fibroblasts, fibrocytes, epithelialization ratio, and collagen deposition and improve antioxidant status compared to the control group (p < 0.05). DISCUSSION AND CONCLUSION: ZMEO accelerated the healing process of infected wounds by shortening the inflammatory factors and increasing proliferative phase. Applying ZMEO only and/or in combination with chemical agents for the treatment of wound healing could be suggested.

Characterization of silk sutures coated with propolis and biogenic silver nanoparticles (AgNPs); an eco-friendly solution with wound healing potential against surgical site infections (SSIs)

Background/aim: Bacterial adherence to a suture material is one of the main causes of surgical site infections. An antibacterial suture material with enhanced wound healing function may protect the surgical site from infections. Thus, the present study aimed to investigate the synergistic effect of propolis and biogenic metallic nanoparticles when combined with silk sutures for biomedical use. Materials and methods: Silver nanoparticle (AgNP) synthesis was carried out via a microbial-mediated biological route and impregnated on propolis-loaded silk sutures using an in situ process. Silk sutures fabricated with propolis and biosynthesized AgNPs (bioAgNP-propolis-coated sutures) were intensively characterized using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). The antibacterial characteristics of the bioAgNP-propolis-coated sutures were evaluated using the agar plate method. The biocompatibility of the bioAgNP-propolis- coated sutures was evaluated using 3T3 fibroblast cells, and their wound-healing potential was also investigated. Results: BioAgNP-propolis-coated sutures displayed potent antibacterial activity against pathogenic gram-negative and gram-positive bacteria, Escherichia coli and Staphylococcus aureus, respectively. BioAgNP-propolis-coated silk sutures were found to be biocompatible with 3T3 fibroblast cell culture. In vitro wound healing scratch assay also demonstrated that the extract of bioAgNP-propolis-coated sutures stimulated the 3T3 fibroblasts' cell proliferation. Conclusion: Coating the silk sutures with propolis and biogenic AgNPs gave an effective antibacterial capacity to surgical sutures besides providing biocompatibility and wound healing activity.

Ciprofloxacin-resistant Aeromonas hydrophila cellulitis following leech therapy.

We report a case of surgical site infection with ciprofloxacin-resistant Aeromonas hydrophila following leech therapy. Antimicrobial and genetic analyses of leech and patient isolates demonstrated that the resistant isolates originated from the leech gut microbiota. These data suggest that ciprofloxacin monotherapy as a prophylaxis regimen prior to leech therapy may not be effective in preventing infection.

Kyphectomy for congenital kyphosis due to meningomyelocele: a case treated with a modified approach to skin healing.

This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135°-15° postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity.

[Application of thermostream method in the surgical treatment of infectious pancreatic diseases].

Application of thermostream method secures a safe sterilization in infected pancreatic affection. It was confirmed by the results of 9 operations, performed on pigs with follow-up to 270 days. Thermal influence toward infected pancreatic tissue was delivered using hot air stream during 20 sec for 1 cm2 area in temperature 140 degrees C. Interstitial oedema is local after thermostream processing of pancreas, the reversible structural-functional changes were revealed in the organ tissues, localized aside from the influence zone. According to bacteriological investigations data obtained, microflora was absent. Successful clinical trial of thermostream method in patients with infected pancreatic affection in an acute necrotic pancreatitis permits to recommend its wide application in surgical practice.

[Clinicopathologic basis of ozonomagnetophoresis in treatment of festering wounds].

Results of treatment of 60 patients with festering wounds were comparatively studeid. According to the mode of local treatment the patients were divided into 2 groups: wound irrigation with ozone was carried out in the first group; in the second group local ozone therapy was carried out in combination with low-frequency magnetic fields--ozonomagnetophoresis. Bactericidal effect and antibiotic susceptibility of microflora is more marked using ozonomagnetophoresis. Tendency to purulo-necrotic tissue rejection from wound surface, regress of inflammation exudative stage with natural forming of granulation tissue in relatively short terms, its accelerated maturing and reparation are histologicaly marked.

Simvastatin improves the healing of infected skin wounds of rats.

PURPOSE: This study explores the potential of the simvastatin to ameliorate inflammation and infection in open infected skin wounds of rats. METHODS: Fourteen Wistar rats weighing 285 +/- 12g were used. The study was done in a group whose open infected skin wounds were treated with topical application of simvastatin microemulsion (SIM, n=7) and a second group with wounds treated with saline 0.9 % (SAL, n=7). A bacteriological exam of the wounds fluid for gram positive and gram negative bacteria, the tecidual expression of TNFá and IL-1â by immunohistochemical technique, and histological analysis by HE stain were performed. RESULTS: The expression of TNFa could be clearly demonstrated in lower degree in skin wounds treated with simvastatin (668.6 +/- 74.7 ìm(2)) than in saline (2120.0 +/-327.1 ìm(2)). In comparison, wound tissue from SIM group displayed leukocyte infiltration significantly lower than that observed in SAL group (p<0.05). Culture results of the samples taken from wound fluid on fourth post treatment day revealed wound infection in only one rat of group simvastatin (SIM), where Proteus mirabilis, Escherichia coli and Enterobacter sp were isolated. In the rats whose wounds were treated with saline (SAL), polymicrobial infection with more than 100,000 CFU/g was detected in all the wounds. CONCLUSION: In addition to its antiinflammatory properties, the protective effects of simvastatin in infected open skin wounds is able to reduce infection and probably has antibacterial action. The potential to treat these wounds with statins to ameliorate inflammation and infection is promising.

Simvastatin improves the healing of infected skin wounds of rats

PURPOSE: This study explores the potential of the simvastatin to ameliorate inflammation and infection in open infected skin wounds of rats. METHODS: Fourteen Wistar rats weighing 285±12g were used. The study was done in a group whose open infected skin wounds were treated with topical application of sinvastatina microemulsion (SIM, n=7) and a second group with wounds treated with saline 0.9 percent (SAL, n=7). A bacteriological exam of the wounds fluid for gram positive and gram negative bacteria, the tecidual expression of TNFá and IL-1â by imunohistochemical technique, and histological analysis by HE stain were performed. RESULTS: The expression of TNFa could be clearly demonstrated in lower degree in skin wounds treated with simvastatin (668.6 ± 74.7 ìm²) than in saline (2120.0 ± 327.1 ìm²). In comparison, wound tissue from SIM group displayed leukocyte infiltration significantly lower than that observed in SAL group (p<0.05). Culture results of the samples taken from wound fluid on fourth post treatment day revealed wound infection in only one rat of group simvastatin (SIM), where Proteus mirabilis, Escherchia coli and Enterobacter sp were isolated. In the rats whose wounds were treated with saline (SAL), polymicrobial infection with more than 100,000 CFU/g was detected in all the wounds. CONCLUSION: In addition to its antiinflammatory properties, the protective effects of simvastatin in infected open skin wounds is able to reduce infection and probably has antibacterial action. The potential to treat these wounds with statins to ameliorate inflammation and infection is promising.

OBJETIVO: O presente estudo avaliou o potencial da sinvastatina para atenuar a inflamação e a infecção em feridas abertas infectadas de pele de ratos. MÉTODOS: Foram utilizados 14 ratos Wistar pesando 285±12g. O estudo foi realizado com um grupo de animais cujas feridas abertas infectadas foram tratadas com aplicação tópica de sinvastatina microemulsão (SIM, n=7) e um segundo grupo com feridas tratadas com solução salina 0,9 por cento (SAL n=7). Foi realizado exame bacteriológico do fluido das feridas para detecção de bactérias gram positivas e negativas, a expressão tecidual de TNFá e IL-1â por imunohistoquímica e análise histológica pela coloração H-E. RESULTADOS: A expressão do TNFa pode ser claramente demonstrada em menor grau nas feridas de pele tratadas com sinvastatina (668.6 ± 74.7 ìm²) do que no grupo salina (2120.0 ± 327.1 ìm²). Em comparação, os tecidos das feridas do grupo SIM mostrou infiltração leucocitária significantemente menor do que a observada no grupo SAL (p<0,05). O resultado das culturas realizadas no fluido das feridas no 4° dia de tratamento revelou infecção em apenas um rato do grupo sinvastatina (SIM), onde Proteus mirabilis, Escherchia coli e Enterobacter sp foram isolados. Nos ratos cujas feridas foram tratadas com solução salina (SAL), infecção polimicrobiana com mais de 100,000 UFC/g foi detectada em todas as feridas. CONCLUSÃO: Além de suas propriedades antiinflamatórias, o efeito protetor da sinvastatina em feridas abertas e infectadas de pele é capaz de reduzir a infecção e provavelmente tem ação antibacteriana. O potencial da droga para atenuar inflamação e infecção de feridas é promissor.

Hyaluronic acid binding peptides prevent experimental staphylococcal wound infection.

Staphylococcus aureus is a major cause of surgical wound infections. The development of mechanisms of antimicrobial resistance by this and other bacterial pathogens has prompted the search for new approaches to treat infectious diseases. Hyaluronic acid binding peptides have been shown to modulate cellular trafficking during host responses and were assessed for their ability to treat and possibly prevent experimental surgical wound infections caused by S. aureus. Treatment with these peptides was highly efficacious in reducing the number of S. aureus cells at the wound site and ameliorated the inflammatory host response associated with these infections. These data suggest a novel approach for the treatment and prophylaxis of staphylococcal wound infections in the clinical setting.

Infection prophylaxis of gunshot wounds using probiotics.

OBJECTIVE: To report a new method of surgical infection prophylaxis for postoperative gunshot wounds to the extremities. METHOD: Gunshot wounded animals were divided into three groups: treatment (probiotic Sporobacterin), antibiotic (cephalosporin cefamezin) and control (no treatment). Histological studies of wound-bed tissue were taken on days 1, 3, 5 and 10 of the study. RESULTS: The probiotic administered per os was more effective than antibiotics for prophylaxis of surgical infection. CONCLUSION: The probiotic's effect is based on the natural defence mechanism activated after injury--the bacterial translocation of saprophytic bacteria from the gut to the wound. DECLARATION OF INTEREST: None.

[Prevention of inflammatory complications after mandibular osteosynthesis by a combination of low-frequency ultrasound and laser exposure]. / Profilaktika vospalitel'nykh oslozhnenii posle operatsii osteosinteza nizhnei cheliusti putem primeneniia sochetannogo vozdeistviia nizkochastotnogo ul'trazvuka i lazera.

Clinical and laboratory study of the efficiency of separate and combined use of low-frequency ultrasound and laser exposure of the operative wound for prevention of pyoinflammatory complications during mandibular osteosynthesis was carried out. Clinical parameters of wound reparation in the course of healing and microbiological and cytological findings in various methods of treatment are presented. The results evidence a high efficiency of these physical methods, particularly of their combination.

[An unusual case of self-harm with petroleum distillate]. / Ein ungewöhnlicher Fall von Selbstbeschädigung mit Waschbenzin.

After surgical treatment of an inguinal hernia, a 26-year-old male was discharged from hospital with a well healing surgical wound. Four weeks later he was admitted again with a major localized painful swelling of the soft tissues, whereas the clinical examination revealed no further local or systemic signs of inflammation. The immediate operation disclosed no abscess formation, but a large colliquation necrosis of the subcutaneous tissue with an outstanding petroleum-like odour. On toxicological examination of the necrotic tissue, a respective petroleum distillate was found. The patient was confronted with the suspicion of having injected the petroleum preparation himself to prolong the wound healing and finally admitted the self-mutilating behaviour. The pathophysiology, clinical history and morphological findings are discussed in comparison with case reports of chemically induced self-mutilation.

Microscopic studies in shunts for hydrocephalus.

Valve-regulated systems, used for the treatment of hydrocephalus, were studied with the scanning electron microscope. The study was performed on unused systems of shunt replaced after different pathologies and on systems removed due to cerebrospinal fluid infection. Defects in the material, such as holes and protrusions, were systematically found in new systems. Aged shunts (1--8 years of implantation) as well as those removed in cases of cerebrospinal fluid infections showed important changes in the structure of the material too; it was also found that biological material, such as fibrin, red blood cells and bacteria, were able to adhere to the walls of the catheter tubing. These results indicate that the scanning electron microscope could be a complementary tool to be used in research, diagnosis, and quality control of silicone rubber prosthesis.