Antibacterial and Antibiofilm Potential of Bacterial Cellulose Hydrogel Containing Vancomycin against Multidrug-Resistant Staphylococcus aureus and Staphylococcus epidermidis.

The present study aimed to evaluate the in vitro antibacterial and antibiofilm activity of bacterial cellulose hydrogel produced by Zoogloea sp. (HYDROGEL) containing vancomycin (VAN) against bacterial strains that cause wound infections, such as multidrug-resistant (MDR) Staphylococcus aureus and Staphylococcus epidermidis. Initially, HYDROGEL was obtained from sugar cane molasses, and scanning electron microscopy (SEM) was performed to determine morphological characteristics. Then, VAN was incorporated into HYDROGEL (VAN-HYDROGEL). The antibacterial activity of VAN, HYDROGEL, and VAN-HYDROGEL was assessed using the broth microdilution method to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) against methicillin-sensitive S. aureus (MSSA) ATCC 25923, methicillin-resistant S. aureus (MRSA) ATCC 33591, S. epidermidis INCQS 00016 (ATCC 12228), five clinical isolates of MRSA, and nine clinical isolates of methicillin-resistant S. epidermidis, following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Additionally, the antibacterial activity of VAN, HYDROGEL, and VAN-HYDROGEL was studied using the time-kill assay. Subsequently, the antibiofilm activity of VAN, HYDROGEL, and VAN-HYDROGEL was evaluated using crystal violet and Congo red methods, as well as SEM analysis. VAN and VAN-HYDROGEL showed bacteriostatic and bactericidal activity against MRSA and methicillin-resistant S. epidermidis strains. HYDROGEL did not show any antibacterial activity. Analysis of the time-kill assay indicated that HYDROGEL maintained the antibacterial efficacy of VAN, highlighting its efficiency as a promising carrier. Regarding antibiofilm activity, VAN and HYDROGEL inhibited biofilm formation but did not demonstrate biofilm eradication activity against methicillin-resistant S. aureus and S. epidermidis strains. However, it was observed that the biofilm eradication potential of VAN was enhanced after incorporation into HYDROGEL, a result also proven through images obtained by SEM. From the methods carried out in this study, it was possible to observe that HYDROGEL preserved the antibacterial activity of vancomycin, aside from exhibiting antibiofilm activity and enhancing the antibiofilm effect of VAN. In conclusion, this study demonstrated the potential of HYDROGEL as a candidate and/or vehicle for antibiotics against MDR bacteria that cause wound infections.

Evaluation of Sensitivity in Specific Points of the Areola and Nipple of Patients Submitted to Reduction Mammoplasty With Periareolar Dermis Release: A Randomized Controlled Study.

BACKGROUND: To date, studies on periareolar dermis release have recorded the areola sensitivity as a mean. Despite being clinically reported by patients, specific points of the areola may present sensitivities not detected when researchers only consider mean values. OBJECTIVES: The aim of this study was to determine the pressure sensitivity at specific points of the nipple-areola complex and compare these values with the mean value measured in the areolas of patients undergoing reduction mammaplasty with periareolar dermis release. METHODS: This is a prospective, randomized controlled trial of 39 consecutive patients (78 breasts) who underwent surgery for treatment of breast hypertrophy; the same surgical technique was used for all patients. In each patient, 1 breast was assigned to a control group and the other to an experimental group. The periareolar dermis release was performed in the experimental group (39 breasts). Pressure sensitivity was tested with Semmes-Weinstein monofilaments on the papilla and at 4 specific points of the areola. The evaluations were conducted preoperatively and at 3 weeks, 6 weeks, and 1 year postoperatively. RESULTS: The group comparisons show a statistically significant difference in sensitivity at the medial point of the areola and in the papilla at 3 weeks postoperation. This difference disappeared in the 1-year evaluation. This recovery profile also occurs when areola sensitivity corresponds to a mean value. The sensitivity significantly decreased at the lower point of the areola up to 1 year postoperation in the control and experimental groups. CONCLUSIONS: The periareolar dermis release did not compromise the pressure sensitivity at the points evaluated in the nipple-areola complex. The mean areola sensitivity differed from the sensitivity at the lower point of the areola.

Evaluation of the Sensitivity of the Nipple-Areola Complex in Patients Undergoing Breast Ptosis Correction with Periareolar Dermis Release: A Randomized Controlled Trial.

BACKGROUND: In the surgical treatment of breast ptosis, the plastic surgeon's main challenge is to mobilize the nipple-areola complex (NAC) over long distances, preserving its sensitivity. Herein, we aimed to evaluate the NAC sensitivity following a periareolar dermis release in patients undergoing surgical correction of breast ptosis. METHODS: This is a prospective, double-blinded, randomized study in which 39 patients (78 breasts) were operated on for the treatment of breast ptosis. Patients' breasts were divided into two groups, each breast in a group. In breasts of the experiment group, the periareolar dermis release was used after decortication. This maneuver was not used in the control group's breasts. To analyze the sensitivity in relation with the distance that the NAC should be mobilized to correct breast ptosis, the value of 6 cm was used as boundary. Sensitivity of the NAC was assessed with monofilaments preoperatively and postoperatively-at three and six weeks and one year. RESULTS: Regarding the sensitivity of the areola, a significant difference was observed in the comparison between the control and experiment groups at the NAC mobility ≤ 6.0 cm in the preoperative. Regarding the nipple, a significant difference was observed in the comparison between the control and experiment groups at three weeks postoperatively for a NAC mobility ≤ 6.0 cm. After one year, there was no difference in the comparison between the groups in either areola or nipple. CONCLUSION: The periareolar dermis release does not compromise NAC vascularization and pressure sensitivity in patients undergoing breast ptosis correction. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Secondary lower limbs lymphedema in patients with Chikungunya fever.

Chikungunya fever (CHIKF) is an arbovirus characterized by acute fever, myalgia and polyarthralgia. Lymphedema in the lower limbs (LL) was observed in several patients during an outbreak of CHIKF in the state of Pernambuco (Brazil) in 2016. No reports on lymphatic vessels disease due to CHIKF have been described. The aim of the study was to follow lymphatic abnormalities in the LL of 16 patients with CHIKF, using lymphoscintigraphy.An observational, prospective study with patients in the acute phase of CHIKF (confirmed serological diagnosis) with LL edema submitted to clinical evaluation and lymphoscintigraphy at baseline and after 90 days.Sixteen patients (81% females) participated in this study. All patients presented with lower limb lymphedema, being 15 (94%) bilateral. Of the 31 limbs affected by lymphedema, 24 (77%) presented abnormalities in lymphatic drainage by lymphoscintigraphy. The delay to visualize pelvic lymph nodes was the most frequent lymphoscintigraphic abnormality, observed in 16 (51,6%) LL. Nine (56%) patients were clinically reevaluated after 90 days, and all 18 LL remained with lymphedema. A second lymphoscintigraphy showed persistent abnormalities in 13 (72%) of the 18 LL.CHIKF can lead to lymphedema, and lymphedema may persist or progress after 3 months of the acute phases of the disease.

Cellulose exopolysaccharide from sugarcane molasses as a suitable substrate for 2D and 3D neuron and astrocyte primary cultures.

Bacteria-synthesized polysaccharides have attracted interest for biomedical applications as promising biomaterials to be used as implants and scaffolds. The present study tested the hypothesis that cellulose exopolysaccharide (CEC) produced from sugarcane molasses of low cost and adequate purity would be suitable as a template for 2D and 3D neuron and/or astrocyte primary cultures, considering its low toxicity. CEC biocompatibility in these primary cultures was evaluated with respect to cell viability, adhesion, growth and cell function (calcium imaging). Polystyrene or Matrigel® matrix were used as comparative controls. We demonstrated that the properties of this CEC in the 2D or 3D configurations are suitable for differentiation of cortical astrocytes and neurons in single or mixed cultures. No toxicity was detected in neurons that showed NMDA-induced Ca2+ influx. Unlike other polysaccharides of bacterial synthesis, the CEC was efficient as a support even in the absence of surface conjugation with extracellular matrix proteins, maintaining physiological characteristics of cultured neural cells. These observations open up the perspective for development of a novel 3D biofunctional scaffold produced from bacterial cellulose and obtained from renewable sources whose residues are not pollutants. Its low cost and possibility to be manufactured in scale are also suitable for potential applications in regenerative medicine.

Bioprosthetic mesh of bacterial cellulose for treatment of abdominal muscle aponeurotic defect in rat model.

The use of meshes for treatment of hernias continues to draw attention of surgeons and the industry in the search of an ideal prosthesis. The purpose of this work is to use meshes manufactured from bacterial cellulose, evaluate their organic tissue interaction and compare with an expanded polytetrafluorethylene (ePTFE's) prosthesis used to repair acute defect of muscle aponeurotic induced in rats. Forty-five male Wistar rats were classified using the following criteria: (1) surgical repair of acute muscle aponeurotic defect with perforated bacterial cellulose film (PBC; n = 18); (2) compact bacterial cellulose film (CBC; n = 12) and (3) ePTFE; (n = 15). After postoperative period, rectangles (2 × 3 cm) including prosthesis, muscles and peritoneum were collected for biomechanical, histological and stereological analysis. In all cases, the maximum acceptable error probability for rejecting the null hypothesis was 5 %. Between PBC and CBC samples, the variables of strain (P = 0.011) and elasticity (P = 0.035) were statistically different. The same was found between CBC and ePTFE (elasticity, P = 0.000; strain, P = 0.009). PBC differed from CBC for giant cells (P = 0.001) and new blood vessels (P = 0.000). In conclusion, there was biological integration and biomechanical elasticity of PBC; therefore, we think this option should be considered as a new alternative biomaterial for use as a bio prosthesis.

The Biocompatibility of a Cellulose Exopolysaccharide Implant in the Rabbit Bladder When Compared With Dextranomer Microspheres Plus Hyaluronic Acid.

OBJECTIVE: To evaluate biocompatibility of a cellulosic exopolysaccharide (CEC) as bulking agent in rabbit urinary bladder. MATERIALS AND METHODS: The experimental study was developed at the Nucleus for Experimental Surgery or UFPE. The new agent was injected into the bladder of the adult rabbits using a small abdominal incision. Animals were injected with 0.2 mL of dextranomer microspheres (Dx) plus hyaluronic acid and CEC. The animals were studied after 3 days (G1), 90 days (G2), and 11 months (G3). The biocompatibility was evaluated according to the histologic parameters (presence of blood vessels, inflammatory reaction, and collagen deposition) by a quantitative analysis. The Student paired t test was used for continuous variables, and the scores were compared through the chi-square test. RESULTS: Both materials were structurally homogeneous and free from inflammatory cells or blood vessels (G1). In 3-month samples (G2), CEC areas were densely invaded by fibroblasts and blood vessels. Dx areas were fragmented but still homogeneous and free from cells or blood vessels. Samples from 3 and 11 months showed a significant difference in favor of CEC especially concerning preservation of material in the implant site, as well as the presence of neovascularization. This experimental study represents a positive outcome in terms of reflux resolution in the long term. Further studies may be necessary to confirm its efficacy when in clinical use. CONCLUSION: The CEC exhibited low inflammatory response and integrated with the host tissue better than Dx in the long-term follow-up.

Biocompatibility and cutaneous reactivity of cellulosic polysaccharide film in induced skin wounds in rats.

The development of a skin substitute suitable for immediately performing the function of the lost dermis and epidermis could result in a positive impact on the treatment of patients with extensive skin lesions. A biopolymer film was applied to skin wounds to investigate the biocompatibility and cutaneous reaction and to test its activity as a mechanical barrier and conductor in the healing process. Forty Wistar rats of both sexes were used in the present study. Two excisions were performed in the dorsal part of the skin flaps. The polysaccharide film was applied over one of the incisions and other incision was washed with saline. The time spent for complete healing of both lesions was virtually the same in both groups, during 21 days of observation. The film remained attached to the bed of the exposed wound for an average period of 6 days. There were no statistically significant differences with regard to lesion measurement area at assessment times of 2nd, 7th and 14th postoperative days. At day 21, the scar area showed a significant difference (0.0229). After 40 days, all wounds were completely healed. No statistically significant differences were found between the histological parameters assessed in the experimental and control groups. The cellulosic polysaccharide film integrated well with the tissue showing high biocompatibility and low skin reactivity.

Sugarcane biopolymer patch in femoral vein angioplasty on dogs.

PURPOSE: To evaluate the use of the sugarcane biopolymer membrane in femoral vein patch angioplasty on dogs. METHODS: Eight dogs were submitted to bilateral femoral vein patch angioplasty with a sugarcane biopolymer membrane patch on one side and an expanded polytetrafluoroethylene (e-PTFE) patch on the contralateral side. This research was performed at Experimental Surgical Research Laboratory of the Centro de Ciências da Saúde at Universidade Federal de Pernambuco. The dogs underwent new surgery at 180 days after the patch angioplasty in order to harvest the femoral vein. All the animals were evaluated by clinical examination, measure of femoral vein diameter, venogram, and Doppler fluxometry. The material harvested was sent for histologic study. Each animal served as its own control. RESULTS: In all veins of both groups, there were no cases of infection, rupture, or pseudoaneurysm formation and thrombosis. In both groups, a chronic inflammatory reaction was observed, with lymphocytes, neutrophils, and fibrosis in the outer surface of the patches. Fibrosis was seen in the inner surfaces of all the patches. In e-PTFE patches, invasion by fibroblasts occurred. CONCLUSIONS: The sugarcane biopolymer membrane can be used as a patch in femoral vein angioplasty on dogs. CLINICAL RELEVANCE: The sugarcane biopolymer membrane is easily synthesized with a low cost of production. This membrane has been used in many areas of experimental surgery as in the healing of skin wounds, in urinary reconstruction, in reconstruction of tympanic membrane, and as an arterial substitute, but there is no report of its use as a vein substitute. In order to evaluate the possibility of using the sugarcane biopolymer membrane in venous reconstructive surgery, this study analyzed its utilization in femoral vein patch angioplasty.

COMPARATIVE MACROSCOPIC STUDY OF OSTEOCHONDRAL DEFECTS PRODUCED IN FEMURS OF RABBITS REPAIRED WITH BIOPOLYMER GEL CANE SUGAR.

OBJECTIVE: To study the surface, coloring, consistency, continuity and healing of osteochondral defects produced in the femoral condyles of rabbits and filled with sugar cane biopolymer gel (SCBG), after 90, 120 and 180 days, and in comparison with a control group. METHOD: Sixteen adult New Zealand white rabbits aged 6 to 7 months, weighing between 2 and 2.5 kg and without locomotor system abnormalities were studied. In all the animals, a defect was made in the femoral condyles of the right and left knees, measuring 3.2 mm in diameter and 4 mm in depth, using a trephine. The animals were divided into two groups: study group formed by the right knees, in which the medial and lateral condyles received implants of SCBG; and control group formed by the left knees, in which the medial and lateral condyles were allowed to heal naturally. The knees were assessed 90, 120 and 180 days after the operation. After the animals had been sacrificed, the anatomical specimens were resected and placed in Bouin's solution. They were then photographed with a Nikon Coolpix 5400(®) coupled to a Nikon SM2800(®) stereoscopic loupe, to analyze the surface, coloring, consistency, continuity and healing. RESULTS: The results were evaluated using the chi-square test. There were no significant differences in the macroscopic assessments of healing between the study and control groups. CONCLUSION: With regard to the surface, coloring, consistency, continuity and healing of the defects, the macroscopic appearance of the tissue repaired with SCBG was similar to that of the control group.