Effectiveness of antimicrobial-coated sutures for the prevention of surgical site infection: a review of the literature

OBJECTIVE:Surgical site infections (SSIs) are the third most common hospital-acquired infections and account for 14% to 16% of all such infections, and suture material may play a role in SSI rate. Given this risk of infection, sutures with antimicrobial activity have been developed. Both in vitro and in vivo experiments have shown that triclosan-coated sutures (TCS) are effective in the prevention of SSIs. Our aim is to analyze currently available RCTs, comparing the effect of antimicrobial-coated suture (ACS) with uncoated suture on the occurrence of SSIs following surgical procedures, we highlighted major contributions of most significant studies and evaluate the current "state of the art" on antimicrobial-coated sutures.MATERIALS AND METHODS: We reviewed 15 RCTs comparing antimicrobial-coated sutures with conventional sutures and assessing the clinical effectiveness of antimicrobial sutures to decrease the risk for SSIs. We focused our attention on each variable in all the analyzed study. RESULTS:Our selected RCTs, produced controversial results: 7 RCTs demonstrated a significant benefit, on the contrary, 8 RCTs presented a comparison in which there was no difference.CONCLUSIONS:On the basis of our selected trial results and the heterogeneous findings of our 7 selected meta-analyses, we conclude that even though the question of whether TCSs could reduce the occurrence of SSI remains still open, the antimicrobial suture was effective in decreasing the risk for postoperative SSIs in a broad population of patients undergoing surgery. Alternative substances are becoming clinically relevant, such as Chlorhexidine (CHX) coated sutures and only 6 in vivo scientific studies evaluated them. In vivo studies, large and comparative clinical research trials are necessary to validate the efficacy of CHX-coated sutures thus allowing their use in clinical practice

The Use of Peripheral Blood-Mononuclear Cells in Scleroderma Patients: An Observational Preliminary Study

Introduction: Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by vasculopathy and excessive production of collagen, which lead to skin and visceral fibrosis. The aim of our study is to assess the potential benefits of autologous peripheral blood mononuclear cells (PBMCs) implants in the treatment of clinical manifestations such as mouth impairment, hand disability, digital ulcers and Raynaud’s phenomenon in Scleroderma patients. Methods: From February 2016 to May 2019, 10 female patients were enrolled from the outpatient clinic of the Plastic Surgery Unit of Sapienza University of Rome. Parameters evaluated were: patients’ disability, using the Health Assessment Questionnaire (HAQ) disability index (DI) and the scleroderma HAQ (sHAQ); mouth opening capacity, by measuring the maximum interincisal distance and the mouth perimeter; hand mobility, assessed with clinical exam and the Hand Mobility in Scleroderma (HAMIS) scale; Raynaud’s phenomenon, evaluated through nailfold capillaroscopy; digital ulcers, examined through their features and incidence of appearance. SPSS software was used for a simple descriptive statistical analysis performed by the Student’s paired t-test. P values less than 0.05 were considered statistically significant. Results: The treatment showed a significant improvement of all the parameters evaluated at 1-year follow-up, it was well-tolerated by all the patients and the only complications noticed were small areas of ecchymosis. Conclusions: With our preliminary study we tought to exploit PBMCs capability to induce angiogenesis widely described in literature in order to treat the vasculopathy-related manifestations of SSc, in patients with no chance for lipofilling. Our results suggest that PBMCs injection could represent a treatment option to take into account for SSc patients. The procedure we used is easy and fast to perform, minimally invasive and not-operator dependent. We hope our observational and preliminary study could be considered as a starting point for further research studies

Cryo-EM structure of a helicase loading intermediate containing ORC-Cdc6-Cdt1-MCM2-7 bound to DNA

In eukaryotes, the Cdt1-bound replicative helicase core MCM2-7 is loaded onto DNA by the ORC-Cdc6 ATPase to form a prereplicative complex (pre-RC) with an MCM2-7 double hexamer encircling DNA. Using purified components in the presence of ATP-γS, we have captured in vitro an intermediate in pre-RC assembly that contains a complex between the ORC-Cdc6 and Cdt1-MCM2-7 heteroheptamers called the OCCM. Cryo-EM studies of this 14-subunit complex reveal that the two separate heptameric complexes are engaged extensively, with the ORC-Cdc6 N-terminal AAA+ domains latching onto the C-terminal AAA+ motor domains of the MCM2-7 hexamer. The conformation of ORC-Cdc6 undergoes a concerted change into a right-handed spiral with helical symmetry that is identical to that of the DNA double helix. The resulting ORC-Cdc6 helicase loader shows a notable structural similarity to the replication factor C clamp loader, suggesting a conserved mechanism of action

“ Lesioni da stravaso di farmaci antiblastici: 25 anni di esperienza.”

BACKGROUND-AIM Nonostante tutti i mezzi utilizzati nella pratica clinica per prevenire la fuoriuscita di farmaci antiblastici dalla vena durante la chemioterapia, lo stravaso è un evento possibile e, se non trattato in tempo, associato a conseguenze anche molto gravi. Ad oggi non esiste un protocollo standard di trattamento. Mancano studi randomizzati per motivi etici e studi che arruolino un vasto numero di pazienti. Noi proponiamo un‘ampia casistica ed un protocollo di trattamento standard valido per lo stravaso di tutti i tipi di farmaci antiblastici somministrati sia in mono che in polichemioterapia, facile da eseguire ed effettuabile in regime ambulatoriale. METHODS La nostra casistica dal 1990 al 2015 comprende 565 casi di stravaso certo di farmaci antiblastici sottoposti ad infiltrazione di soluzione salina sterile al livello sottocutaneo al fine di interrompe l’azione lesiva locale del farmaco. RESULTS La nostra tecnica ci ha permesso in alcuni casi di evitare il danno da stravaso, mentre nei pazienti con stravaso ormai avvenuto, di ottenere una netta riduzione dell’evoluzione necrotica. Dal 1990 ad oggi, infatti, solo 27 casi sono stati sottoposti ad intervento chirurgico. CONCLUSIONS Il nostro protocollo può essere applicato per qualsiasi farmaco chemioterapico, anche se non noto o iniettato in associazione con altri farmaci. Inoltre il nostro approccio conservativo trova il suo razionale di impiego proprio perché è rivolto a pazienti immunodepressi e psicologicamente fragili, allo scopo di garantire loro la migliore qualità di vita, ricordando che il miglior trattamento è la prevenzione

“Ear-lobe keloids: treatment by a protocol of homeopathic therapy, surgical excision and application of 2-octyl cyianoacrylate”

Background: Keloids are abnormal wound reactions of connective tissue. Auricular keloids can develop as a result of dermal injuries such as ear piercing or skin trauma. Keloids are painful and itchy and, together with their aesthetic discomfort, compromise patients’ quality of life. A wide variety of therapeutic modalities are currently in use. Although the literature on the subject is wide, there is still no effectiveness-established treatment for keloids cure. Our aim is to present the authors’ experience evaluating the combined approach consisted of homeopathic therapy, surgical resection and application of a tissue adhesive to treat ear lobe keloids. Methods: we studied 13 consecutive patients (9 females, 4 males) aged from 15 to 65 years old (mean age: 40 years) with earlobe keloids caused by piercing or surgical injury. The keloids varied in size 2 x 1 to 5 x 3,2 cm. Treatment consisted of six monthly of homeopathic therapy consisting of antihomotoxic preparations acting on evolution of scarring process. In case of satisfied results in terms of redness and stiffness reduction and symptomatic improvement, maintained for at least three months, in the ninth month homeopathic therapy was continued for a six month period, during which intralesional excision of keloid was performed and the defect was closed with a tissue adhesive kept on site for one month. Examination took into account both subjective parameters (pain, itching) and objective parameters (thickness, stiffness, redness, recurrence). Assessment based on clinical observation and photographic documentation. The primary end-point was the number of patients who achieved major flattening of the keloid (defined as a reduction of more than 80% of the keloid) at the time of the study after a minimum follow-up of 24 months after treatment. Results: After homeopathic therapy we observed improvement in both scar stiffness and redness and pain and itching reduction. After surgery we achieved reduction in keloid thickness more than 80%, of the keloid and no relapses at 24 months follow up in all cases. Conclusion: the combination of homeopathic therapy, (well-tolerated especially in young patients), surgical excision and application of 2-octyl Cyianoacrylate, is effective for treatment of earlobe keloid. Even though our proposed therapy is long lasting, on the other hand no relapse was observed. However, studies are needed to evaluate accepted and experimental therapies including larger number of patients

Gli epiteliomi cutanei in pazienti portatori di altre neoplasie

SUMMARY Basal and squamous cells carcinoma in patients affected by others cancers. Skin cancers are a common disease, but unusual is their association with other tumors. The Authors have studied the patients presenting skin cancers (BCC and SCC) in association with a cancer not involving the cutaneous district, with the purpose to evaluate ali the possible ethiologies of the skin cancer. This retrospective research has included all the people treated for BCC and/or SCC by the Plastic Surgery Unit of the University of Rome «La Sapienza», during 36 months (March 1987-May 1990). In this time 433 people have been treated for skin cancers, among them nine (7 males, 2 females) presented also another neoplastic disease. We have observed three kinds of links among the neoplastic associations: the cutaneous neoplasy may rise as a consequence of an organic-immunologic deficit in the patient, may be caused by the treatment underwent to heal from the first cancer, or the association seems to happen by hazar

La nostra esperienza presso l’ambulatorio “complicanze da fillers” della Sapienza Università di Roma

Con il termine “filler”, (dall’inglese “to fill”=riempire) si definisce una sostanza, di varia natura, che può essere iniettata nei tessuti molli al fine di migliorare i volumi e gli effetti dell’invecchiamento L’utilizzo di tali materiali è aumentato notevolmente negli anni. L’incremento del numero di utilizzatori, del numero e varietà di sostanze, l’assenza di protocolli di uso standardizzati e l’aumento dei casi di effetti avversi e complicanze legato all’uso dei filler ci ha spinto all’apertura, presso il nostro ambulatorio di Chirurgia Plastica Sapienza Università di Roma di un centro di riferimento dedicato al trattamento delle complicanze da filler. Nei 15 anni di attività di questo ambulatorio abbiamo potuto fare alcune considerazioni. Spesso i pazienti si avvicinano a questi trattamenti con estrema superficialità, non considerandoli procedure mediche associate a possibili complicanze. In molti casi, i pazienti non sono a conoscenza del materiale iniettato e non sono in grado di contattare il professionista che ha eseguito il trattamento. Inoltre alcuni pazienti hanno riferito l’utilizzo di materiali e/o ambienti non idonei, arrivando addirittura all’auto-inoculazione. Vengono riportati alcuni dei casi giunti alla nostra osservazione