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Despite reductions in bacterial infection and enhanced success rate, the widespread use of systemic antibiotic prophylaxis in implant dentistry is controversial. This use has contributed to the growing problem of antimicrobial resistance, along with creating significant health and economic burdens. The basic mechanisms that cause implant infection can be targeted by new prevention and treatment methods which can also lead to the reduction of systemic antibiotic exposure and its associated adverse effects. This review aims to summarize advanced biomaterial strategies applied to implant components based on anti-pathogenic mechanisms and immune balance mechanisms. It emphasizes that modifying the dental implant surface and regulating the early immune response are promising strategies, which may further prevent or slow the development of peri-implant infection, and subsequent failure. [ABSTRACT FROM AUTHOR]

Bacterial biofilms on orthopedic implants are resistant to the host immune response and to traditional systemic antibiotics. Novel therapies are needed to improve patient outcomes. TRL1068 is a human monoclonal antibody (mAb) against a biofilm anchoring protein. For assessment of this agent in an orthopedic implant infection model, efficacy was measured by reduction in bacterial burden of Staphylococcus aureus, the most common pathogen for prosthetic joint infections (PJI). Systemic treatment with the biofilm disrupting mAb TRL1068 in conjunction with vancomycin eradicated S. aureus from steel pins implanted in the spine for 26 of 27 mice, significantly more than for vancomycin alone. The mechanism of action was elucidated by two microscopy studies. First, TRL1068 was localized to biofilm using a fluorescent antibody tag. Second, a qualitative effect on biofilm structure was observed using scanning electron microscopy (SEM) to examine steel pins that had been treated in vivo. SEM images of implants retrieved from control mice showed abundant three-dimensional biofilms, whereas those from mice treated with TRL1068 did not. Clinical Significance: TRL1068 binds at high affinity to S. aureus biofilms, thereby disrupting the three-dimensional structure and significantly reducing implant CFUs in a well-characterized orthopedic model for which prior tested agents have shown only partial efficacy. TRL1068 represents a promising systemic treatment for orthopedic implant infection. [ABSTRACT FROM AUTHOR]

Featured Application: This study provides information about the effects of laser irradiation provided against peri-implant infection on titanium and supports the best choice of having lesser titanium implant damage. Over the past 10 years, the number of dental implants has grown significantly. This increase has consequently led to an elevation of the statistics related to cases of peri-implantitis. Laser therapy has conquered a place among the therapies of excellence to treat peri-implantitis. However, the laser device used could influence the therapy's success. The aim of this comparative experimental work was to highlight the differences in the work on grade 4 titanium surfaces of the most commonly used laser lights in this field, taking into consideration any structural damage that lasers could cause to implant surfaces. The lasers examined were a 980 nm diode laser; a 1064 nm Nd:YAG laser; and a new generation of 1064 nm Nd:YAG Q-switch nano pulsed laser. We evaluated the titanium temperature increase, the pre- and post-treatment two-dimensional surface appearance observed under the scanning electron microscope; finally, the three-dimensional pre- and post-treatment topographic analysis was assessed using atomic force microscopy. We showed that the 1064-nm Q-switch Nd:YAG nanosecond pulsed laser appears to be more suitable for the preservation of implant morphology because of the absence of the induction of metal damage. [ABSTRACT FROM AUTHOR]

Prosthetic joint infections (PJIs) can have disastrous consequences for patient health, including removal of the device, and placement of cemented implants is often required during surgery to eradicate PJIs. In translational research, in vivo models are widely used to assess the biocompatibility and antimicrobial efficacy of antimicrobial coatings and compounds. Here, we aim to utilize Galleria mellonella implant infection models to assess the antimicrobial activity of antibiotic-loaded bone cement (ALBC) implants. Therefore, we used commercially available bone cement loaded with either gentamicin alone (PALACOS R+G) or with a combination of gentamicin and vancomycin (COPAL G+V), compared to bone cement without antibiotics (PALACOS R). Firstly, the in vitro antimicrobial activity of ALBC was determined against Staphylococcus aureus. Next, the efficacy of ALBC implants was analyzed in both the G. mellonella hematogenous and early-stage biofilm implant infection model, by monitoring the survival of larvae over time. After 24 h, the number of bacteria on the implant surface and in the tissue was determined. Larvae receiving dual-loaded COPAL G+V implants showed higher survival rates compared to implants loaded with only gentamicin (PALACOS R+G) and the control implants without antibiotics (PALACOS R). In conclusion, G. mellonella larvae infection models with antibiotic-loaded bone cements are an excellent option to study (novel) antimicrobial approaches. [ABSTRACT FROM AUTHOR]

Peri-prosthetic breast infections pose a risk of severe complications after breast implant surgery. The need to remove the breast implant, control the infection and perform additional surgical procedures are the consequences. Reimplantation of an alloplastic implant is only appropriate after an infection-free interval. In this retrospective cohort study, we investigated the effectiveness of negative pressure wound treatment with instillation and dwell time (NPWTi-d) on peri-prosthetic breast infections in combination with implant removal and antibiotic therapy. Twelve patients treated with NPWTi-d due to breast implant infection were included in the study. The bacterial burden was analyzed using wound swabs before and after NPWTi-d. Additionally, laboratory values were determined before NPWTi-d and immediately before wound closure. A total of 13 peri-prosthetic breast infections in 12 patients were treated using implant removal and NPWTi-d. In 76.9% (n = 10) of the cases, the patients had undergone alloplastic breast reconstruction following cancer-related mastectomy, whereas 23.1% (n = 3) of the patients had undergone breast augmentation for cosmetic reasons. The bacterial burden in the breast pocket decreased statistically significant after implant removal and NPWTi-d. No shift from Gram-positive to Gram-negative bacteria was observed. Inflammatory markers rapidly decreased following treatment. NPWTi-d had a positive impact on the healing process after peri-prosthetic breast infections, leading to a decrease in bacterial burden within the wounds and contributing to uneventful healing. Therefore, secondary reimplantation of breast prostheses might be positively influenced when compared to conventional implant removal and simple secondary closure. Further studies are required to conclusively establish the beneficial long-term effects of using NPWTi-d for the treatment of peri-prosthetic breast infections. [ABSTRACT FROM AUTHOR]

Background: The reconstruction of large breasts carries a heightened risk profile. While skin-reducing mastectomy (SRM) techniques facilitate the correction of breast ptosis, they are frequently associated with a high incidence of vascular complications. This study compares two SRM techniques—the horizontal incision and the classic inverted T incision—by examining their clinical and surgical outcomes. Methods: We retrospectively analyzed data from 24 patients (30 breasts) who underwent SRM with immediate prosthetic reconstruction between 2019 and 2023 at the European Institute of Oncology in Milan, Italy. Our comparison focused on breast aesthetic outcome, reconstruction quality, complication rates (early and late), and patient satisfaction, utilizing the BREAST-Q questionnaire to gauge the latter. Results: Among the 24 patients included in the study, 16 (20 breasts) were treated with the inverted T technique, and 8 (10 breasts) with the horizontal incision approach. A higher overall complication rate was observed with the inverted T technique compared to the horizontal method, with early complications outnumbering late ones. The most common issues were recurrent seroma and skin necrosis leading to implant exposure. Notably, there were no cases of implant infection. Although the horizontal incision technique achieved slightly higher patient satisfaction scores, the difference was not statistically significant. Discussion: The inverted T and horizontal incision techniques each have unique benefits and drawbacks. Our findings indicate enhanced patient satisfaction and reduced complication rates with the horizontal incision technique. The selection of the technique should be customized based on the patient's individual risk factors, tissue quality, and preferences. [ABSTRACT FROM AUTHOR]

Simple Summary: With the increase in the mastectomy rate, the number of patients opting for postmastectomy reconstruction has been rising, with implant-based procedures being the most commonly used method. One of the most feared complications is the loss of reconstruction, often caused by implant infection. This can lead to prolonged antibiotic treatments, additional surgical procedures, capsular contracture, and unsatisfactory aesthetic results, with a significant psychological impact on patients. This study analyzed infection rates at our institution and evaluated the effectiveness of our prevention protocol introduced in 2020, comparing the data on surgical site infections (SSIs) between Trieste Hospital (with the protocol) and another center in Gorizia (without the protocol). We enrolled 396 patients, divided into the experimental group (Trieste) and the control group (Gorizia). Infected patients were 5 in the first group (1.7%) and 8 in the second group (7.9%), with an overall infection rate of 3.2%. We conclude that the prevention protocol has reduced the incidence of postoperative infections. Background: With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients. Aims: The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures. Methods and Results: We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%. Conclusion: After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite medical advancements, post-operative infections in osteosynthesis remain common, causing complications like delayed healing and implant failure. Investigating microbial colonization after surgery in small animals, this study aims to understand infection rates and influencing factors. Results from 71 explants show correlations between infection, patient characteristics, and surgical variables. Notably, factors like body weight, implant type, and additional injuries impact infection development. Surprisingly, while microorganisms were present in nearly half of the cases, only 7.3% led to clinical complications. These findings highlight the complexity of post-operative infections and suggest that microbial presence does not always lead to complications, offering insights for improved treatment strategies in veterinary medicine, potentially reducing patient suffering and healthcare costs. Despite recent advancements in antibiotics, hygienic measures, and peri-operative systemic antibiotics, post-operative infections in osteosynthesis remain prevalent and continue to be among the most common surgical complications, leading to delayed fracture healing, osteomyelitis, implant loosening, and loss of function. Osteosynthesis implants are routinely utilized in veterinary medicine and the current study investigates the microbial colonization of implants following osteosynthesis in small animals, along with its incidence and influencing factors. The results are analyzed in regard to correlations between infection, patient, disease progression, and radiographic images, as well as other factors that may promote infection. Seventy-one explants from sixty-five patients were examined and evaluated for microbial colonization. Factors like body weight and age, location and type of plate and additional injuries like lung lesions, the surgeon's experience, or the number of people present during the surgical procedure seem to influence the development of an infection. Of the animals, 60% showed osteolytic changes and 73.3% of those with dysfunctional mobility had an implant infection. Microorganisms were detected in almost 50% of the explants, but a clinically relevant infection was only present in five patients (7.3%), suggesting that the presence of microorganisms on an implant does not necessarily lead to treatment complications. [ABSTRACT FROM AUTHOR]

Postoperative implant infection is a severe complication in orthopedic surgery, often leading to implant failure. Current treatment strategies mainly rely on systemic antibiotic therapies, despite contributing to increasing bacterial resistance. In recent years, nanomaterials have gained attention for their potential in anti-infection methods. They exhibit more substantial bactericidal effects and lower drug resistance than conventional antimicrobial agents. Nanomaterials also possess multiple bactericidal mechanisms, such as physico-mechanical interactions. Additionally, they can serve as carriers for localized antimicrobial delivery. This review explores recent applications of nanomaterials with different morphologies in post-orthopedic surgery infections and categorizes their bactericidal mechanisms. [ABSTRACT FROM AUTHOR]

Surface treatment of metallic implants plays a crucial role in orthopedics and orthodontics. Metallic implants produce side-effects such as physical, chemical/electro-chemical irritations, oligodynamic/catalytic and carcinogenic effects. These effects cause bacterial infections and account for huge medical expenses. Treatment for these infections comprises repeated radical debridement, replacement of the implant device and intravenous or oral injection antibiotics. Infection is due to the presence of bacteria in the patient or the surrounding environment. The antibiotic-based medication prevents prophylaxis against bacterial colonization, which is an emphatic method that may otherwise be catastrophic to a patient. Therefore, preventive measures are essential. A coating process was developed with its drug infusion and effect opposing biofilms. Modification in the medical implant surface reduces the adhesion of bacterial and biofilms, the reason behind bacterial attachment. Other polymer-based and nanoparticle-based carriers are used to resolve implant infections. Therefore, using an implant coating is a better approach to prevent infection due to biofilm. [ABSTRACT FROM AUTHOR]

Implant infections caused by Staphylococcus aureus are difficult to treat due to biofilm formation, which complicates surgical and antibiotic treatment. We introduce an alternative approach using monoclonal antibodies (mAbs) targeting S. aureus and provide evidence of the specificity and biodistribution of S.-aureus-targeting antibodies in a mouse implant infection model. The monoclonal antibody 4497-IgG1 targeting wall teichoic acid in S. aureus was labeled with indium-111 using CHX-A"-DTPA as a chelator. Single Photon Emission Computed Tomography/computed tomographyscans were performed at 24, 72 and 120 h after administration of the 111In-4497 mAb in Balb/cAnNCrl mice with a subcutaneous implant that was pre-colonized with S. aureus biofilm. The biodistribution of this labelled antibody over various organs was visualized and quantified using SPECT/CT imaging, and was compared to the uptake at the target tissue with the implanted infection. Uptake of the 111In-4497 mAbs at the infected implant gradually increased from 8.34 %ID/cm3 at 24 h to 9.22 %ID/cm3 at 120 h. Uptake at the heart/blood pool decreased over time from 11.60 to 7.58 %ID/cm3, whereas the uptake in the other organs decreased from 7.26 to less than 4.66 %ID/cm3 at 120 h. The effective half-life of 111In-4497 mAbs was determined to be 59 h. In conclusion, 111In-4497 mAbs were found to specifically detect S. aureus and its biofilm with excellent and prolonged accumulation at the site of the colonized implant. Therefore, it has the potential to serve as a drug delivery system for the diagnostic and bactericidal treatment of biofilm. [ABSTRACT FROM AUTHOR]

Dental implants are widely used to restore missing teeth because of their stability and comfort characteristics. Peri-implant infection may lead to implant failure and other profound consequences. It is believed that peri-implantitis is closely related to the formation of biofilms, which are difficult to remove once formed. Therefore, endowing titanium implants with anti-adhesion properties is an effective method to prevent peri-implant infection. Moreover, anti-adhesion strategies for titanium implant surfaces are critical steps for resisting bacterial adherence. This article reviews the process of bacterial adhesion, the material properties that may affect the process, and the anti-adhesion strategies that have been proven effective and promising in practice. This article intends to be a reference for further improvement of the antibacterial adhesion strategy in clinical application and for related research on titanium implant surfaces. [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) is a common human pathogen that causes several difficult-to-treat infections, including biofilm-associated infections. The biofilm-forming ability of S. aureus plays a pivotal role in its resistance to most currently available antibiotics, including vancomycin, which is the first-choice drug for treating MRSA infections. In this study, the ability of thymol (a monoterpenoid phenol isolated from plants) to inhibit biofilm formation and to eliminate mature biofilms, was assessed. We found that thymol could inhibit biofilm formation and remove mature biofilms by inhibiting the production of polysaccharide intracellular adhesin (PIA) and the release of extracellular DNA (eDNA). However, cotreatment with thymol and vancomycin was more effective at eliminating MRSA biofilms, in a mouse infection model, than monotherapy with vancomycin. Comparative histopathological analyses revealed that thymol reduced the pathological changes and inflammatory responses in the wounds. Assessments of white blood cell counts and serum TNF-α and IL-6 levels showed reduced inflammation and an increased immune response following treatment with thymol and vancomycin. These results indicate that combinatorial treatment with thymol and vancomycin has the potential to serve as a more effective therapy for MRSA biofilm-associated infections than vancomycin monotherapy. [ABSTRACT FROM AUTHOR]

Additively manufactured (AM) porous titanium implants may have an increased risk of implant-associated infection (IAI) due to their huge internal surfaces. However, the same surface, when biofunctionalized, can be used to prevent IAI. Here, we used a rat implant infection model to evaluate the biocompatibility and infection prevention performance of AM porous titanium against bioluminescent methicillin-resistant Staphylococcus aureus (MRSA). The specimens were biofunctionalized with Ag nanoparticles (NPs) using plasma electrolytic oxidation (PEO). Infection was initiated using either intramedullary injection in vivo or with in vitro inoculation of the implant prior to implantation. Nontreated (NT) implants were compared with PEO-treated implants with Ag NPs (PT-Ag), without Ag NPs (PT) and infection without an implant. After 7 days, the bacterial load and bone morphological changes were evaluated. When infection was initiated through in vivo injection, the presence of the implant did not enhance the infection, indicating that this technique may not assess the prevention but rather the treatment of IAIs. Following in vitro inoculation, the bacterial load on the implant and in the peri-implant bony tissue was reduced by over 90% for the PT-Ag implants compared to the PT and NT implants. All infected groups had enhanced osteomyelitis scores compared to the noninfected controls. [ABSTRACT FROM AUTHOR]

Breast implants can be removed with breast explantation surgery (BES) for various reasons, including patient dissatisfaction, capsular contracture, implant infection or rupture, breast implant-associated anaplastic large cell lymphoma, and a recently emerging phenomenon called breast implant illness. There is very limited data on the imaging appearance after BES. A retrospective chart review was performed for patients with BES findings on imaging reports for the period between October 2016 and October 2021. When assessing BES techniques, a key element is determining whether the implant's fibrous capsule requires removal. The second important question is if the patient requires an additional aesthetic procedure after BES. BES techniques include capsulotomy, and partial, total, or en bloc capsulectomy. Adjunctive aesthetic or reconstructive procedures after BES include fat grafting, mastopexy, augmentation, and reconstruction with flaps. The majority of post-BES breast imaging findings are related to the surgical scar/bed, thereby confirming that the type of explantation surgery is important. Imaging findings after BES include focal and global asymmetries, architectural distortions, calcifications, calcified and non-calcified fat necrosis, masses, hematomas, seromas, capsular calcifications, and silicone granulomas. Most importantly, since these patients have residual breast tissue, paying attention to imaging features that are suspicious for breast cancer is necessary. [ABSTRACT FROM AUTHOR]

Background: Disseminated Mycobacterium chimaera (M. chimaera) infection following cardiac surgery has been associated with a high mortality. The long-term impact of surgery and the appropriate surgical approach are still matters of debate. Methods: From 2015 to 2019, seven patients with M. chimaera infection following cardiac surgery were isolated. Results: The median incubation time was 30 months (IQR 18–38). Echocardiography was unremarkable in three patients (43%). We decided to redo cardiac surgery in all patients and explanted all previously implanted prosthetic material. All explant cultures yielded M. chimaera. One patient (14%) died in-hospital seven months after the redo surgery. After a median follow-up of 59.6 months (IQR 39.1–69.6), we observed three infection relapses among the survivors (43%), presumably due to concomitant extracardiac infection and recurrent cardiac implant infection. Conclusions: M. chimaera infection following cardiac surgery is associated with a delayed and unspecific clinical presentation. Echocardiogaphy has a limited sensitivity for prosthetic valve infection with M. chimaera, and negative findings should not preclude the surgical decision. The extraction of all previously implanted material is crucial to achieving the source control, as the re-implantation of prosthetic material as well as uncontrolled extracardiac infection at the time of the redo cardiac surgery appear to be key factors for persisting/relapsing infection. [ABSTRACT FROM AUTHOR]

Capsular contracture is the most frequently associated complication following breast implant placement. Biofilm formation on the surface of such implants could significantly influence the pathogenesis of this complication. The objective of this study was to design an experimental model of breast implant infection that allowed us to compare the in vivo S. epidermidis ability to form and perpetuate biofilms on commonly used types of breast implants (i.e., macrotexturized, microtexturized, and smooth). A biofilm forming S. epidermidis strain (ATCC 35984) was used for all experiments. Three different implant surface types were tested: McGhan BIOCELL® (i.e., macrotexturized); Mentor Siltex® (i.e., microtexturized); and Allergan Natrelle Smooth® (i.e., smooth). Two different infection scenarios were simulated. The ability to form biofilm on capsules and implants over time was evaluated by quantitative post-sonication culture of implants and capsules biopsies. This experimental model allows the generation of a subclinical staphylococcal infection associated with a breast implant placed in the subcutaneous tissue of Wistar rats. The probability of generating an infection was different according to the type of implant studied and to the time from implantation to implant removal. Infection was achieved in 88.9% of macrotextured implants (i.e., McGhan), 37.0% of microtexturized implants (i.e., Mentor), and 18.5% of smooth implants (i.e., Allergan Smooth) in the short-term (p < 0.001). Infection was achieved in 47.2% of macrotextured implants, 2.8% of microtexturized implants, and 2.8% of smooth implants (i.e., Allergan Smooth) in the long-term (p < 0.001). There was a clear positive correlation between biofilm formation on any type of implant and capsule colonization/infection. Uniformly, the capsules formed around the macro- or microtexturized implants were consistently macroscopically thicker than those formed around the smooth implants regardless of the time at which they were removed (i.e., 1–2 weeks or 3–5 weeks). We have shown that there is a difference in the ability of S epidermidis to develop in vivo biofilms on macrotextured, microtextured, and smooth implants. Smooth implants clearly thwart bacterial adherence and, consequently, biofilm formation and persistence are hindered. [ABSTRACT FROM AUTHOR]

The objective of this study was to clinically and radiologically evaluate the performance of a short (8 mm), 1-piece, zirconia implant after an observation period of 1 year in function. A total of 47 patients with 1 missing tooth in the position of a premolar or molar were recruited. Short (8 mm), 1-piece, zirconia implants were placed and loaded after a healing period of 2 to 4 months with monolithic crowns made of 3 different materials. Implants were followed up for one year and clinically and radiologically assessed. A total of 46 implants were placed. One was excluded since no primary stability was achieved at implant placement. At the 1-year follow-up, mean marginal bone loss 1 year after loading was 0.05 ± 0.47 mm. None of the implants showed marginal bone loss greater than 1 mm or clinical signs of peri-implantitis. A total of 2 implants were lost during the healing phase and another after loading, resulting in a survival rate of 93% after 1 year. All lost implants showed a sudden increased mobility with no previous signs of marginal bone loss or peri-implant infection. The short, 8 mm, zirconia implants showed stable marginal bone levels over the short observation period of 1 year. Although they revealed slightly lower survival rates, they can be suggested for the use in sites with reduced vertical bone. Scientific data are very limited, and long-term data are not yet available, and therefore, they are needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the biofilm formation of Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Escherichia coli on titanium implants with CAD-CAM tooling techniques. Twenty specimens of titanium were studied: Titanium grade 2 tooled with a Planmeca CAD-CAM milling device (TiGrade 2), Ti6Al4V grade 5 as it comes from CAD-DMLS device (computer aided design-direct metal laser sintering device) (TiGrade 5), Ti6Al4V grade 23 as it comes from a CAD-CAM milling device (TiGrade 23), and CAD-DMLS TiGrade 5 polished with an abrasive disc (TiGrade 5 polished). Bacterial adhesion on the implants was completed with and without saliva treatment to mimic both extraoral and intraoral surgical methods of implant placement. Five specimens/implant types were used in the bacterial adhesion experiments. Autoclaved implant specimens were placed in petri plates and immersed in saliva solution for 30 min at room temperature and then washed 3× with 1× PBS. Bacterial suspensions of each strain were made and added to the specimens after saliva treatment. Biofilm was allowed to form for 24 h at 37 °C and the adhered bacteria was calculated. Tooling techniques had an insignificant effect on the bacterial adhesion by all the bacterial strains studied. However, there was a significant difference in biofilm formation between the saliva-treated and non-saliva-treated implants. Saliva contamination enhanced S. mutans, S. aureus, and E. faecalis adhesion in all material types studied. S. aureus was found to be the most adherent strain in the saliva-treated group, whereas E. coli was the most adherent strain in the non-saliva-treated group. In conclusion, CAD-CAM tooling techniques have little effect on bacterial adhesion. Saliva coating enhances the biofilm formation; therefore, saliva contamination of the implant must be minimized during implant placement. Further extensive studies are needed to evaluate the effects of surface treatments of the titanium implant on soft tissue response and to prevent the factors causing implant infection and failure. [ABSTRACT FROM AUTHOR]

The infection of surgically placed implants is a problem that is both large in magnitude and that broadly affects nearly all surgical specialties. Implant-associated infections deleteriously affect patient quality-of-life and can lead to greater morbidity, mortality, and cost to the health care system. The impact of this problem has prompted extensive pre-clinical and clinical investigation into decreasing implant infection rates. More recently, antimicrobial approaches that modify or treat the implant directly have been of great interest. These approaches include antibacterial implant coatings (antifouling materials, antibiotics, metal ions, and antimicrobial peptides), antibacterial nanostructured implant surfaces, and antibiotic-releasing implants. This review provides a compendium of these approaches and the clinical applications and outcomes. In general, implant-specific modalities for reducing infections have been effective; however, most applications remain in the preclinical or early clinical stages. [ABSTRACT FROM AUTHOR]

The inhibition of bacterial adhesion to implant surfaces can prevent implant infection. With the gradual advancement of research on implant infections, the future function of medical implant surface coatings is definitely not single and mechanical, but more intelligent and multifunctional, to fit the antimicrobial characteristics of different stages and sites, as well as other special needs. The implant-bone contact surface is an important interface where bacteria and cells compete to win the "race for the surface" of the implant [[2]]. In addition to this, the demand for implants is growing dramatically in other medical specialties, such as dentistry, cardiovascular surgery and neurosurgery, where preventing implant infections is a common and constant theme. [Extracted from the article]

Background: Tumescent local anesthesia (TLA) is widely used in esthetic surgery due to its ability to reduce complications, eliminate the need for general anesthesia, provide effective pain control, and shorten hospitalization times. Methods: This study evaluates the use of TLA in 80 patients who underwent augmentation mastopexy between 2010 and 2022. A tumescent solution containing 500 mg lidocaine, 672 mg sodium bicarbonate, and 1 mg epinephrine in 1000 mL of saline was infiltrated, with an average of 300 mL per breast. The surgical technique involved creating a subpectoral pocket for textured round implants (250–400 cc), followed by careful hemostasis. Results: No patients required conversion to general anesthesia, and there were no signs of toxicity or major complications. Minor complications included wound dehiscence (6.2%), hematoma (2.5%), and capsular contracture (2.5%). Pain management satisfaction at 3 months post-surgery was rated as "outstanding" by 12.5% of patients, "excellent" by 67.5%, and "good" by 20%. The longest follow-up was 6 years, with no implant ruptures except one (1.2%). Conclusions: While the study did not include a control group or statistical analysis, the findings suggest that TLA is a safe and effective alternative to general anesthesia for augmentation mastopexy, providing excellent pain control and a low rate of complications. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa is a harmful pathogen that causes a variety of acute and chronic infections through quorum sensing (QS) mechanisms. The increasing resistance of this bacterium to numerous antibiotics has created a demand for new medications that specifically target QS. Endophytes can be the source of compounds with antibacterial properties. This research is the first to examine tannic acid (TA) produced by endophytic fungus as a potential biotherapeutic agent. A novel endophytic fungal isolate identified as Penicillium oxalicum was derived from the cladodes of Opuntia ficus-indica (L.). The species identification for this isolate was confirmed through sequencing of the internal transcribed spacer region. The metabolites from the culture of this isolate were extracted using ethyl acetate, then separated and characterized using chromatographic methods. This led to the acquisition of TA, a compound that shows strong anti-QS and excellent antibacterial effects against extensively drug-resistant P. aeruginosa strains. Furthermore, it was shown that treating P. aeruginosa with the obtained TA reduced the secretion of virulence factors controlled by QS in a dose-dependent manner, indicating that TA inhibited the QS characteristics of P. aeruginosa. Simultaneously, TA significantly inhibited the expression of genes associated with QS, including rhlR/I, lasR/I, and pqsR. In addition, in silico virtual molecular docking showed that TA could efficiently bind to QS receptor proteins. Our results showed that P. oxalicum could be a new source of TA for the treatment of infections caused by extensively drug-resistant P. aeruginosa. [ABSTRACT FROM AUTHOR]

Peri-implantitis disease has increased significantly over the last years, resulting in increased failure of implants. Many factors may play a role in implant complications and failure, including ones related to the oral microbiota. This literature review aims to summarize the current knowledge of microbiome of implants in health and disease, focusing not only on the presence/absence of specific microbiota or on their relative abundance, but also on their phenotypic expression and their complex relationships with the host. The authors examined the MEDLINE database and identified key topics about peri-implant oral microbiome in health and disease. The peri-implant microbiome differs from that of the tooth, both in health and disease, as they are structurally and chemically different. The adhesion and formation of the peri-implant biofilm can be affected by the surface energy, topography, wettability, and electrochemical charges of the implant surface. In addition, the morphogenesis of the tissues surrounding the dental implant also differs from the tooth, making the dental implant more susceptible to bacterial infection. This interplay between the microbiome and the host immune system in peri-implant infections still needs to be elucidated. [ABSTRACT FROM AUTHOR]

Prosthetic joint infection (PJI) is a major complication following total arthroplasty. Rising antimicrobial resistance (AMR) to antibiotics will further increase therapeutic insufficiency. New antibacterial technologies are being developed to prevent PJI. In vivo models are still needed to bridge the translational gap to clinical implementation. Though rabbit models have been used most frequently, there is no consensus about methodology and measured outcomes. The PubMed, Scopus, and EMBASE databases were searched for literature on PJI in rabbit models. Data extraction included bias control, experimental design, and outcome measures of the NZW rabbit models in the articles. A total of 60 articles were included in this systematic literature review. The articles were divided into six groups based on the PJI intervention: no intervention used (21%), revision surgery (14%), prevention with only antibiotics (21%), prevention with surface modifications (7%), prevention with coatings (23%), and others (14%). Despite the current availability of guidelines and recommendations regarding experimental design, bias control, and outcome measures, many articles neglect to report on these matters. Ultimately, this analysis aims to assist researchers in determining suitable clinically relevant methodologies and outcome measures for in vivo PJI models using NZW rabbits to test new antimicrobial technologies. [ABSTRACT FROM AUTHOR]

This study aimed to assess clinical and radiographic outcomes, including implant survival, marginal bone loss, and patient satisfaction, in individuals with severe bone atrophy treated using a newly developed system of short and extra-short implants. A total of 44 implants (37 short and 7 extra-short) were placed with immediate loading in 11 patients. The patients were followed up at between 6 and 24 months. Bone changes, keratinized mucosa, bleeding on probing, probing depth, crown-to-implant ratio, and patient satisfaction were evaluated. An implant survival and success rate of 100% was observed. The peri-implant bone condition showed no significant associations between marginal bone loss (MBL) and gingival recession. In extra-short implants, the crown-to-implant ratio did not affect MBL in the evaluated times. However, short implants showed a statistically significant inverse correlation between mesial measurement and crown-to-implant ratio (p = 0.006) and between distal measurement and crown-to-implant ratio (p = 0.004) over six months. Plaque was present in the mesiobuccal regions in 38.64% of the implants, with extra-short implants having the highest relative frequency (71.4%). Bleeding was observed in 18.9% of the short implants in the mesiolingual region and 14.3% of the extra-short implants. There was a statistically significant association between bleeding on probing in the mesiobuccal region and the type of implant (p = 0.026). The analysis of probing depth showed no difference between the types of implants. Within the limits of this study, short and extra-short implants presented similar clinical and radiographic behavior of soft and hard tissues in the evaluated times. [ABSTRACT FROM AUTHOR]

This study investigates the antibacterial N-heterocyclic carbene (NHC)–silver complexes using the SwissADME platform, a web-based tool developed by the Swiss Institute of Bioinformatics (SIB). NHCs, particularly their silver complexes, have gained significant interest in medicinal chemistry for their potential as antibacterial and anticancer agents. The effectiveness of these complexes is closely linked to their structure, including factors like lipophilicity, which enhance their ability to penetrate bacterial cells and sustain the release of active silver ions. SwissADME provides computational estimates of pharmacokinetic properties, including absorption, distribution, metabolism, and excretion (ADME) characteristics, as well as drug-likeness and toxicity assessments. By evaluating parameters like molecular weight, topological polar surface area, lipophilicity (LogP), and water solubility, SwissADME offers insights into the drug-like potential of compounds. This study is inspired by a comprehensive review of antibacterial NHC–silver complexes published from 2006 to 2023, which identified superior structures with notable biological activity. The primary aim is to determine whether these active complexes exhibit distinct SwissADME parameters compared to others, providing a deeper understanding of the factors that influence their biological efficacy and aiding in the identification of promising drug candidates. Finally, experimental stabilities of exemplary complexes were confronted with absolute LUMO values derived from DFT calculations. [ABSTRACT FROM AUTHOR]

Preparing electrospun fibers by applying a potential difference between a polymeric solution and a contacting substrate is increasingly attracting attention in tissue engineering applications. Among the numerous polymers, polycaprolactone (PCL) bioscaffold has been widely investigated due to its biocompatibility and biodegradability. Bioactive powder can be added to further improve its performance. In the present study, bioactive glass powder modified by adding 0–6 wt.% antibacterial zinc element (coded as ZBG) was prepared through the sol–gel process. Furthermore, PCL bioscaffolds with various ZBG additions were prepared using the electrospinning technique. The zinc-doped bioactive glass powder and electrospun PCL/ZBG bioscaffolds were evaluated using scanning electron microscopy, X-ray diffraction and Fourier-transform infrared spectroscopy to determine their structural properties. Additionally, in vitro bioactivity, biocompatibility and antibacterial performance were investigated. Experimental results showed that sol–gelled ZBG powder possessed superior bioactivity and 0.8 g ZBG was the optimal addition to prepare PCL/ZBG bioscaffolds with. All the electrospun PCL/ZBG bioscaffolds were biocompatible and their antibacterial performance against two S. aureus strains (SA133 and Newman) improved with increasing zinc concentration. Electrospun PCL/ZBG bioscaffolds exhibited excellent bioactivity and have great potential for biomedical application. [ABSTRACT FROM AUTHOR]

Osteoporosis, a prevalent ailment worldwide, compromises bone strength and resilience, particularly afflicting the elderly population. This condition significantly heightens susceptibility to fractures even from trivial incidents, such as minor falls or impacts. A major challenge in diagnosing osteoporosis is the absence of discernible symptoms, allowing osteoporosis to remain undetected until the occurrence of a fracture event. Early symptom detection and swift diagnosis are critical for preventing severe issues related to bone diseases. Assessing bone turnover markers aids in identifying, diagnosing, and monitoring these conditions, guiding treatment decisions. However, conventional techniques for measuring bone mineral density are costly, time-consuming, and require specialized expertise. The integration of sensor technologies into medical practices has transformed how we monitor, diagnose, and treat various health conditions, including bone health and orthopedics. This review aims to provide a comprehensive overview of the current state of sensor technologies used in bone, covering their integration with bone tissue, various applications, recent advancements, challenges, and future directions. [ABSTRACT FROM AUTHOR]

Background/Aim: The stability of peri-implant tissues is crucial for the long-term success of dental implant treatments. A new cervical implant design has been developed to address the challenges associated with peri-implant tissue stability, featuring a concave cervical portion to increase tissue volume in this area. The present study aimed to clinically evaluate the effectiveness of the new cervical implant design in maintaining peri-implant tissue stability. Materials and Methods: Five clinical cases involving completely edentulous patients were selected, in which 25 implants were installed. The marginal bone level around each implant was assessed at three different time points—T0: immediately after the prosthesis installation, T1: 6 months post installation, and T2: at the last control visit, up to 38 months later. Measurements were taken to analyze changes in marginal bone levels (MBLs) and the keratinized mucosa (KM) over time. Furthermore, the keratinized mucosa (KM) around the implants was evaluated. Results: The mean and standard deviation values of the marginal bone levels at each time point were as follows—T0: 0.59 ± 0.55 mm; T1: 1.41 ± 0.59 mm; T2: 1.76 ± 0.69 mm. Statistical analysis showed significant differences across the time points (ANOVA p < 0.0001). The overall mean KM values were 3.85 mm for T1 and T2, showing the stability of the peri-implant soft tissues at ≥1-year controls. Conclusion: Within the limitations of the present study, the results showed that the Collo implants presented measured MBL values increasing within the time range analyzed in each case but within the normal values cited in the literature for these types of rehabilitation treatments. However, the measured KM values presented, in all cases, an average above the values referenced in the literature as a minimum for maintaining the health of the peri-implant tissues. [ABSTRACT FROM AUTHOR]

The rise of antibiotic-resistant strains demands new alternatives in antibacterial treatment. Bacteriophages, with their precise host specificity and ability to target and eliminate bacteria safely, present a valuable option. Meanwhile, hydrogels, known for their excellent biodegradability and biocompatibility, serve as ideal carriers for bacteriophages. The combination of bacteriophages and hydrogels ensures heightened phage activity, concentration, controlled release, and strong antibacterial properties, making it a promising avenue for antibacterial treatment. This article provides a comprehensive review of different crosslinking methods for phage hydrogels, focusing on their application in treating infections caused by various drug-resistant bacteria and highlighting their effective antibacterial properties and controlled release capabilities. [ABSTRACT FROM AUTHOR]

Although titanium and its alloys are widely used as dental implants, they cannot induce the formation of new bone around the implant, which is a basis for the functional integrity and long-term stability of implants. This study focused on the functionalization of the titanium/titanium oxide surface as the gold standard for dental implants, with electrospun composite fibers consisting of polyvinylpyrrolidone and Ca2+ ions. Polymer fibers as carriers of Ca2+ ions should gradually dissolve, releasing Ca2+ ions into the environment of the implant when it is immersed in a model electrolyte of artificial saliva. Scanning electron microscopy, energy dispersive X-ray spectroscopy and attenuated total reflectance Fourier transform infrared spectroscopy confirmed the successful formation of a porous network of composite fibers on the titanium/titanium oxide surface. The mechanism of the formation of the composite fibers was investigated in detail by quantum chemical calculations at the density functional theory level based on the simulation of possible molecular interactions between Ca2+ ions, polymer fibers and titanium substrate. During the 7-day immersion of the functionalized titanium in artificial saliva, the processes on the titanium/titanium oxide/composite fibers/artificial saliva interface were monitored by electrochemical impedance spectroscopy. It can be concluded from all the results that the composite fibers formed on titanium have application potential for the development of osteoinductive and thus more biocompatible dental implants. [ABSTRACT FROM AUTHOR]

Introduction: Sacral fractures are rare but are increasing in incidence among trauma patients. They are associated with a wide variety of complications, most commonly neurologic defects. Case Report: A 59-year old woman initially underwent open reduction internal fixation (ORIF) for a sacral fracture, after which the patient developed an infection, wound complications, and hardware failure. The revision of the iliosacral screws proved challenging in that the standard screw and washer could not achieve sufficient compression of the fracture. Therefore, a modified midfoot mesh plate was cut to size and used as a washer to gain more surface area, achieving fixation. The plate was applied laterally and cut to cover as much surface area as possible without unnecessary bony overhang. A trans-iliac trans-sacral screw was then inserted in the standard fashion, thus allowing the plate to act as a washer. This resulted in an excellent outcome with appropriate fracture healing. Conclusion: We describe the case of an iliosacral screw revision in which a modified midfoot mesh plate was used as a washer. This resulted in appropriate fixation in the revision settings. The principles described to achieve this fixation can be broadly applied in the setting of orthopedic fractures. [ABSTRACT FROM AUTHOR]

Biomaterials consist of both natural and synthetic components, such as polymers, tissues, living cells, metals, and ceramics. Their purpose is focused on repairing or replacing malfunctioning living tissues and organs. Therefore, it is imperative to ensure the safety and sterility of biomaterials before any contact with living tissue. Ultraviolet (UV)-C irradiation for biomaterial disinfection has been considered due to the high recurrence rate of bacterial infections and to prevent resistance. Physical composition and surface properties and UV-C sensitivity of microorganisms can alter its efficacy. The main objective of this study was to evaluate the efficacy of UV-C in terms of microbial lethality and additional underlying factors contributing to its performance, namely the surface properties. For this purpose, twelve different strains were first screened, from which four microorganism species known to have the ability to cause nosocomial infections were further tested, namely Escherichia coli, Pseudomonas aeruginosa, Candida albicans, and Candida glabrata. These microorganisms were inoculated onto slides and disks of various bio contact surfaces, including glass (GLS), titanium (Ti), and poly ether etherketone (PEEK), and exposed to UV-C. The results demonstrate that bacterial pathogens on biomaterial surfaces respond differently to UV-C light exposure, and the bactericidal effect decreased in this order: glass, PEEK, and Ti (0.5 to 2.0 log reduction differences). P. aeruginosa ATCC 27853 on glass surfaces was reduced to an undetectable level after being exposed to 6.31 J.cm−2 of UV-C, displaying the highest reduction rate observed among all the tested microorganisms, 2.90 J−1.cm−3, compared to Ti and PEEK. Similarly, a higher reduction in C. glabrata ATCC 2001 was observed on glass; the modeled inhibition displayed a rate of 1.30 J−1.cm−3, the highest observed rate among yeast, compared to Ti and PEEK, displaying rates of 0.10 J−1.cm−3 and 0.04 J−1.cm−3, respectively. The inactivation rates were higher for less hydrophobic materials with smoother surfaces as compared to biomaterials with rougher surfaces. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the optimization of computer-aided design/computer-aided manufacturing (CAD/CAM) patient-specific implants for mandibular facial bone defects and compare the biocompatibility and osseointegration of machined titanium (Ma), Sandblasted/Large-grit/Acid-etched (SLA) titanium, and polyetherketoneketone (PEKK) facial implants. We hypothesized that the facial implants made of SLA titanium had superior osseointegration when applied to the gonial angle defect and prevented the senile atrophy of the bone. Histologic findings of the soft-tissue reaction, hard-tissue reaction, and bone–implant contact (BIC (%) of 24 Ma, SLA, and PEKK facial implants at 8 and 12 weeks were investigated. There was no statistical difference in the soft tissue reaction. Bone was formed below the periosteum in all facial implants at 12 weeks and the BIC values were significantly different at both 8 and 12 weeks (p < 0.05). Ma, SLA, and PEKK facial implants are biocompatible with osseointegration properties. SLA can enhance osseointegration and provoke minimal soft tissue reactions, making them the most suitable choice. They provide an excellent environment for bone regeneration and, over the long term, may prevent atrophy caused by an aging mandible. The bone formation between the lateral surface of the facial implant and periosteum may assist in osseointegration and stabilization. [ABSTRACT FROM AUTHOR]

Introduction: Peri-implantitis poses a significant challenge for implant dentistry due to its association with bacterial colonization on implant surfaces and the complexity of its management. This systematic review aims to assess evidence from in vivo studies regarding the antimicrobial efficacy of titanium (Ti) dental implant surfaces following physical/chemical modifications or the application of various metal element coatings in preventing bacterial growth associated with peri-implantitis. Materials and Methods: A literature review was conducted across four scientific databases (PubMed, Embase, Scopus, Web of Science), encompassing in vivo studies published between 2013 and 2024, and 18 reports were included in the systematic review. Results: The findings suggest that titanium dental implant surfaces, following physical/chemical modifications and metal element coatings, exhibit antimicrobial effects against bacteria associated with peri-implantitis in humans and various animal models. Conclusions: The reviewed studies indicated a reduction in bacterial colonization, diminished biofilm formation, and decreased signs of inflammation in the peri-implant tissues, which provides evidence that physical/chemical alterations on titanium dental implant surfaces or metal element coatings, like silver (Ag), zinc (Zn), magnesium (Mg), and copper (Cu), demonstrate antimicrobial properties in in vivo studies. However, caution is warranted when translating findings to clinical practice due to methodological disparities and high bias risks. Further larger-scale clinical trials are imperative to assess their long-term efficacy and validate their clinical applicability. [ABSTRACT FROM AUTHOR]

Objective: The objective was to compare the microbiological characteristics and treatment of early and late surgical site infections (SSIs) in instrumented spinal surgery. Methods: Those patients admitted for SSIs in a single center between January 2010 and December 2022 were included. The subjects were divided into early (eSSIs) and late (lSSIs) SSIs, and demographic, microbiological, treatment, and follow-up data were collected. Results: Instrumented spinal surgery was performed in 2136 patients. Ninety-six cases of infections were identified (prevalence = 4.5%), with 47.9% eSSIs and 52.1% lSSIs. In 58.7% of the cases, the eSSIs were monomicrobial: Staphylococcus aureus (37%) and Enterobacterales (33.3%) were the main bacteria involved. In 66% of the cases, the lSSIs, were monomicrobial: Cutibacterium acnes (30.3%) and staphylococci were predominant. Enterobacterales were isolated in more than 70% of the polymicrobial samples in both the eSSIs and lSSIs. The treatment of the eSSIs mostly consisted of lavage-debridement surgery associated with antibiotic treatment, while the treatment of the lSSIs combined hardware removal or replacement and long-duration antibiotic treatment. A negative outcome was observed in 17.1% of the eSSIs and 5.7% of the lSSIs. Enterobacterales were associated with negative outcomes of eSSIs. Conclusions: Enterobacterales were found in most of the polymicrobial infections regardless of the time of infection onset. Further large studies should be conducted to precisely determine the management and prevention regarding the increasing Gram-negative bacteria SSIs. [ABSTRACT FROM AUTHOR]

Bacterial biofilm on implants may cause inflammation, which disturbs the process of the implant's integration with the surrounding tissues. Such problems are becoming critical for patients' health, especially in connection with the presence of antibiotic-resistant bacterial strains. Among the existing alternatives for drug treatments are natural-based substances. This study focused on the examination of silica coatings with curcumin and thymol, which were deposited using the sol-gel method on 3D printouts made of Ti6Al4V ELI. This substrate material is commonly used in medicine. The selective laser melting technique used for the manufacturing of samples was in line with the existing procedures applied for individual orthopedic implants. The examination involved the assessment of the coatings' morphology, chemical composition, and biological effect. The antibacterial properties were tested using a flow cytometer using Escherichia coli, and the cytotoxicity on Saos-2 cells was assessed using the LIVE/DEAD test. The obtained results showed that it is possible to produce silica sol-gel coatings with the addition of specific natural substances in concentrations assuring a bacteriostatic effect. The produced coatings did not show any cytotoxic effect, which confirms the possibility of using both curcumin and thymol as additives to coatings used in medicine, e.g., for orthopedic implants. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI) affects around 35% of adult women and has a significant impact on quality of life. A single incision sling (SIS), such as Altis®, was introduced to improve original slings and avoid complications. The present study aimed to evaluate the SIS Altis® subjective and objective cure rates of women with SUI, mixed urinary incontinence (MUI), recurrent SUI, and SUI with concomitant prolapse and report its complications from one single medical center. Methodology: A retrospective cohort, unsponsored study was conducted at the Jordan University Hospital. All women patients were treated with the SIS Altis® procedure, and prolapse procedures were also completed as necessary. The chi square analysis for the cure rates was conducted between the subgroups. Results: From June 2016 to June 2019, 111 women patients with a mean age of 48.0 ± 11.3 years underwent a SIS Altis® procedure. The overall outcome resulted in 81% and 85% of patients being subjectively and objectively cured. The subjectively cured MUI patients were significantly fewer than SUI patients (70% versus 86%, p < 0.05), and patients with recurrent SUI had significantly lower rates (56% for subjective and objective cure rates; p < 0.01 and 0.001). Of the 44 patients who underwent SIS Altis® and concomitant vaginal repair surgery, no significant differences in subjective and objective cure rates were observed. Only 2.7% of women had mild pain, 2.7% had vaginal tape erosion, and 9% had to be re-operated on. Conclusions: The Altis® procedure is effective in women who suffer from SUI for a 19-month follow-up period. However, recurrent SUI patients had lower subjective and objective cure rates than primary SUI patients. Further research is needed with a larger sample size in a prospective study design to determine the effectiveness of single SIS in patients with recurrent SUI. [ABSTRACT FROM AUTHOR]

The Gamma Nail represents one of the most popular and efficient implants for treating proximal femoral fractures. Our paper reports a case of a failed Gamma Nail which was used for the surgical treatment of a 69-year-old woman with a right femoral trochanteric fracture due to a car accident. After the surgical intervention, 6 months later, the patient presented to the hospital reporting pain and limited mobility of the right hip. An X-ray was performed at the level of the pelvis, which highlighted the fracture nonunion and the implant failure. The implant removal and its replacement with a dynamic condylar screw system (DCS) was decided. Because Gamma Nail failures are rare occurrences, the implant was subjected to analyses and experimental determinations to find out the cause. For the implant analyses, a stereomicroscope, an optical microscope, and scanning electron microscopy were used. After the tests were conducted, preparation and processing irregularities as causes of the implant failure were eliminated. Also, the experimental analyses showed that the Gamma Nail did comply with chemical composition and microstructure regulations. Thus, it was concluded that the implant failed due to the mechanical overloading caused by surgical technique errors. [ABSTRACT FROM AUTHOR]

Since three-dimensional (3D) bioprinting has emerged, it has continuously to evolved as a revolutionary technology in surgery, offering new paradigms for reconstructive and regenerative medical applications. This review highlights the integration of 3D printing, specifically bioprinting, across several surgical disciplines over the last five years. The methods employed encompass a review of recent literature focusing on innovations and applications of 3D-bioprinted tissues and/or organs. The findings reveal significant advances in the creation of complex, customized, multi-tissue constructs that mimic natural tissue characteristics, which are crucial for surgical interventions and patient-specific treatments. Despite the technological advances, the paper introduces and discusses several challenges that remain, such as the vascularization of bioprinted tissues, integration with the host tissue, and the long-term viability of bioprinted organs. The review concludes that while 3D bioprinting holds substantial promise for transforming surgical practices and enhancing patient outcomes, ongoing research, development, and a clear regulatory framework are essential to fully realize potential future clinical applications. [ABSTRACT FROM AUTHOR]

This study aimed to comprehensively assess the influence of the nanotube diameter and the presence of a silicon carbide (SiC) coating on microbial proliferation on nanostructured titanium surfaces. An experiment used 72 anodized titanium sheets with varying nanotube diameters of 50 and 100 nm. These sheets were divided into four groups: non-coated 50 nm titanium nanotubes, SiC-coated 50 nm titanium nanotubes, non-coated 100 nm titanium nanotubes, and SiC-coated 100 nm titanium nanotubes, totaling 36 samples per group. P. gingivalis and T. denticola reference strains were used to evaluate microbial proliferation. Samples were assessed over 3 and 7 days using fluorescence microscopy with a live/dead viability kit and scanning electron microscopy (SEM). At the 3-day time point, fluorescence and SEM images revealed a lower density of microorganisms in the 50 nm samples than in the 100 nm samples. However, there was a consistently low density of T. denticola across all the groups. Fluorescence images indicated that most bacteria were viable at this time. By the 7th day, there was a decrease in the microorganism density, except for T. denticola in the non-coated samples. Additionally, more dead bacteria were detected at this later time point. These findings suggest that the titanium nanotube diameter and the presence of the SiC coating influenced bacterial proliferation. The results hinted at a potential antibacterial effect on the 50 nm diameter and the coated surfaces. These insights contribute valuable knowledge to dental implantology, paving the way for developing innovative strategies to enhance the antimicrobial properties of dental implant materials and mitigate peri-implant infections. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus [S. aureus] is a leading cause of sepsis and septic arthritis, conditions that pose significant medical challenges due to their high mortality and morbidity. No studies have used an in vivo imaging system [IVIS] to monitor S. aureus sepsis and septic arthritis. Here, we employed a bioluminescent reporter strain of S. aureus, Newman AH5016, administered intravenously to induce sepsis and intra-articularly to induce local septic arthritis in mice. Disease progression was monitored using IVIS to capture bioluminescent signals from kidneys, joints, and whole mice. Cytokines in the blood and joints were measured. The efficacy of cloxacillin treatment was evaluated. In the sepsis model, bioluminescent signals from kidneys, but not from whole mice, were correlated with kidney bacterial load and abscess formation. Ex vivo kidney imaging detected increased bacterial load and abscess formation from day 3 to day 10. Antibiotic treatment significantly reduced kidney signals, correlating with decreased bacterial counts and IL-6 levels, indicating effective infection control. In the local infection model, early-phase bioluminescent signals from joints were correlated with macroscopic arthritis and bacterial burden. Thus, signal detection from kidneys using IVIS is useful for monitoring S. aureus sepsis and assessing antibiotic efficacy, though it may only be effective for early-phase monitoring of local septic arthritis. [ABSTRACT FROM AUTHOR]

Using orthopedic devices or prosthetic joints to treat various conditions is expected in a Traumatology and Orthopedics Unit. Recently, the materials used to build these different devices have evolved; however, pathogens can still infect these materials. Additionally, the immune system has limitations when defending against these pathogens, which results in bacterial infections like Staphylococcus aureus, Methicillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA). A total of 276 patients who attended the Traumatology and Orthopedics Unit of our hospital from 1 June 2018 to 1 June 2019, were included in the present study. Our study analyzed the incidence of S. aureus and other bacterial pathogens in the surgical sites of patients with orthopedic implants, as well as the most used types of implants and implant materials. The specimens obtained from the surgical sites of the patients were cultured in anaerobic and aerobic media for subsequent identification using their phenotypic characteristics. Subsequently, antibiotic susceptibility tests were performed to establish the appropriate treatment. The primary pathogens identified were Staphylococcus aureus (26.4%), followed by Escherichia coli (21.0%) and Staphylococcus epidermidis (15.8%). The most commonly used implants were plates (41.7%), followed by endomedullary nails (20%), Kirschner wires (14.1%), and fixators (10.1%). As for the anatomical regions of the implants, the most frequent sites were the legs, followed by the thighs, wrists, and ankles. The pathogens were more susceptible to ciprofloxacin (95%), clindamycin (89%), and cefotaxime (86%). S. aureus is the primary infectious agent in our hospital, with an incidence of 26.4% after the placement of orthopedic implants. Although its incidence was lower compared to other tertiary hospitals, it is necessary to improve aseptic techniques in such a way as to reduce the incidence of this pathogen further. [ABSTRACT FROM AUTHOR]

One of the complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). Numerous studies have been performed to explore the value of biological parameters in the early identification of infection rates after THA and TKA. This study investigates alterations in inflammatory markers associated with PJI. This retrospective study focused on a cohort of patients with hip and knee arthroplasty treated between 2016 and 2022. CRP, ESR, and fibrinogen were observed preoperatively, on days one, three, six, and twenty-one postoperatively. From a total of 4076 THA and TKA performed during this period, 62 patients were identified with periprosthetic infections. We also identified the pathogens responsible for infections in order to assess if asymptomatic preoperative infections were involved in PJI. In patients with acute infections following TKA, days one and three postoperative recorded a CRP value below the expected range. The value of CRP in patients with early infection after THA was significantly increased on day six postoperative. ESR and fibrinogen values were not statistically significantly correlated with early PJI. The CRP level in acute PJI shows different patterns than those shown in the literature. [ABSTRACT FROM AUTHOR]

RhlR plays a key role in the quorum sensing of Pseudomonas aeruginosa. The current structure–activity relationship (SAR) studies of RhlR inhibitors mainly focus on elucidating the functional groups. Based on a systematic review of previous research on RhlR inhibitors, this study aims to establish a systematic, hierarchical screening model for RhlR inhibitors. We initially established a database and utilized principal component analysis (PCA) to categorize the inhibitors into two classes. Based on the training set, pharmacophore models were established to elucidate the structural characteristics of ligands. Subsequently, molecular docking, molecular dynamics simulations, and the calculation of binding free energy and strain energy were performed to validate the crucial interactions between ligands and receptors. Then, the screening criteria for RhlR inhibitors were established hierarchically based on ligand structure characteristics, ligand–receptor interaction, and receptor affinity. Test sets were finally employed to validate the hierarchical virtual screening model by comparing it with the current SAR studies of RhlR inhibitors. The hierarchical screening model was confirmed to possess higher accuracy and a true positive rate, which holds promise for subsequent screening and the discovery of active RhlR inhibitors. [ABSTRACT FROM AUTHOR]

Implant surface nanofiber (NF) coatings represent an alternative way to prevent/treat periprosthetic joint infection (PJI) via local drug release. We developed and characterized a coaxial erythromycin (EM)-doped PLGA/PCL-PVA NF coating. The purpose of this study was to determine the efficacy of EM-NF coatings (EM0, no EM, EM100 (100 mg/mL), and EM1000 (1000 mg/mL) wt/wt) in a rat PJI model. A strong bond of the EM-NF coating to the surface of titanium (Ti) pins was confirmed by in vitro mechanical testing. Micro-computed tomography (mCT) analysis showed that both EM100 and EM1000 NF effectively reduced periprosthetic osteolysis compared to EM0 at 8 and 16 weeks after implantation. Histology showed that EM100 and EM1000 coatings effectively controlled infection and enhanced periprosthetic new bone formation. The bone implant contact (BIC) of EM100 (35.08%) was higher than negative controls and EM0 (3.43% and 0%, respectively). The bone area fraction occupancy (BAFO) of EM100 (0.63 mm2) was greater than controls and EM0 (0.390 mm2 and 0.0 mm2, respectively). The BAFO of EM100 was higher than that of EM1000 (0.3 mm2). These findings may provide a basis for a new implant surface fabrication strategy aimed at reducing the risks of defective osseointegration and PJI. [ABSTRACT FROM AUTHOR]