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Nambisan RM, Green SR, Kwon RS, Elta GH, Gianchandani YB. A microsystem for in vivo wireless monitoring of plastic biliary stents using magnetoelastic sensors. MICROSYSTEMS & NANOENGINEERING 2024; 10:159. [PMID: 39477941 PMCID: PMC11526028 DOI: 10.1038/s41378-024-00772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 11/02/2024]
Abstract
With an interest in monitoring the patency of stents that are used to treat strictures in the bile duct, this paper reports the investigation of a wireless sensing system to interrogate a microsensor integrated into the stent. The microsensor is comprised of a 28-μm-thick magnetoelastic foil with 8.25-mm length and 1-mm width. Magnetic biasing is provided by permanent magnets attached to the foil. These elements are incorporated into a customized 3D polymeric package. The system electromagnetically excites the magnetoelastic resonant sensor and measures the resulting signal. Through shifts in resonant frequency and quality factor, the sensor is intended to provide an early indication of sludge accumulation in the stent. This work focuses on challenges associated with sensor miniaturization and placement, wireless range, drive signal feedthrough, and clinical use. A swine specimen in vivo experiment is described. Following endoscopic implantation of the sensor enabled plastic stent into the bile duct, at a range of approximately 17 cm, the signal-to-noise ratio of ~106 was observed with an interrogation time of 336 s. These are the first reported signals from a passive wireless magnetoelastic sensor implanted in a live animal.
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Affiliation(s)
- Ramprasad M Nambisan
- EECS Department and Center for Wireless Integrated Microsystems and Sensing, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Scott R Green
- EECS Department and Center for Wireless Integrated Microsystems and Sensing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Richard S Kwon
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Grace H Elta
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Yogesh B Gianchandani
- EECS Department and Center for Wireless Integrated Microsystems and Sensing, University of Michigan, Ann Arbor, MI, 48109, USA
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Tian Y, Yin C, Ma Y, Fu G, Liu R, Ran H, Pan T, Xiao Y, Wen X. Lumen-apposing metal stents versus traditional self-expanding metal stents for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis. Surg Endosc 2024; 38:586-596. [PMID: 38151677 DOI: 10.1007/s00464-023-10636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Endoscopic drainage has become the preferred treatment for pancreatic fluid collections (PFCs). There is still a lack of reliable evidence to prove which metal stent is the best choice for endoscopic ultrasound (EUS)-guided drainage of PFCs. In this study, we aimed to evaluate the efficacy and safety of lumen-apposing metal stents (LAMS) compared to traditional self-expanding metal stents (SEMS) in meta-analysis. METHODS We systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to July 15, 2023. Relevant publications that compared LAMS with traditional SEMS for drainage of patients' PFCs under EUS-guidance were included. This meta-analysis assessed endpoints using Review Manager 5.3 and Stata 14.0 statistical software. RESULT Nine citations comprising 707 patients with PFCs were included. The clinical success rate of LAMS tended to be higher than that of SEMS (RR = 1.07, 95%CI [1.00, 1.15], P = 0.05). LAMS had a lower technical success rate (RR = 0.97, 95%CI [0.94, 0.99], P = 0.02) and faster procedure time (minutes) (MD = - 24.29, 95%CI [- 25.59, - 22.99], P < 0.00001) compared to SEMS. In addition, LAMS had fewer overall adverse events (RR = 0.64, 95%CI [0.48, 0.87], P = 0.004). For specific adverse events, LAMS had fewer migration (RR = 0.37, 95%CI [0.19, 0.72], P = 0.003), occlusion (RR = 0.43, 95%CI [0.22, 0.82], P = 0.01) and infection (RR = 0.38, 95%CI [0.20, 0.70], P = 0.002). There was no significant difference in bleeding and perforation between the two stents. For hospital stay (days), LAMS group was similar to SEMS group (MD = - 3.34, 95%CI [- 7.71, - 1.03], P = 0.13). Regarding recurrence, LAMS group was fewer than SEMS group (RR = 0.41, 95%CI [0.21, 0.78], P = 0.007). CONCLUSION Compared to traditional SEMS, LAMS has a higher clinical success rate, faster procedure time, fewer adverse events, similar hospital stay and lower recurrence rate in EUS-guided drainage of PFCs. LAMS is a good choice with a high technical success rate over 95%, and using a shorter length or "one-step" operation can further improve it. Richer placement experience is required for LAMS placement under EUS-guidance.
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Affiliation(s)
- Yong Tian
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Changjie Yin
- People's Liberation Army, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yihan Ma
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Guochuan Fu
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rui Liu
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hongmei Ran
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tao Pan
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yang Xiao
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xudong Wen
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Yang K, Sun W, Cui L, Zou Y, Wen C, Zeng R. Advances in functional coatings on biliary stents. Regen Biomater 2024; 11:rbae001. [PMID: 38343880 PMCID: PMC10858350 DOI: 10.1093/rb/rbae001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2025] Open
Abstract
Biliary stenting is an important interventional method for the prevention and treatment of biliary tract diseases. However, complications, such as postoperative biliary infection and restenosis, frequently occur due to the extensive scope of the biliary system and the complex composition of bile. The combination of coating technology and biliary stents is expected to bring new approaches to the solution of these problems. The cutting-edge advance on functional coatings on biliary stents is reviewed from seven perspectives: anticorrosion, -bacterial, -tumor, stone-dissolving, X-ray visibility, antistent migration and functional composite coatings. The development trend is also discussed. Overall, the performance of the numerous functional coatings for various purposes is generally up to expectations, but the balance between the medications' effectiveness and their safety needs to be further adjusted. Many contemporary investigations have advanced to the level of animal experiments, offering crucial fundamental assurance for broader human studies. The combination of biliary stents and functional coatings is an innovative idea with great potential for future development.
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Affiliation(s)
- Kaining Yang
- Department of Bioengineering, College of Chemical and Biological Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Wenxin Sun
- Department of Bioengineering, College of Chemical and Biological Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Lanyue Cui
- Corrosion Laboratory for Light Metals, College of Materials Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Yuhong Zou
- Department of Bioengineering, College of Chemical and Biological Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Cuie Wen
- School of Engineering, RMIT University, Melbourne, VIC 3001, Australia
| | - Rongchang Zeng
- Corrosion Laboratory for Light Metals, College of Materials Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
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Yu Z, Yu S, Laijun L, Wenjing L, Chaojing L, Hong J, Fujun W, Lu W. Construction of ultrasmooth PTFE membrane for preventing bacterial adhesion and cholestasis. Colloids Surf B Biointerfaces 2022; 213:112332. [PMID: 35151991 DOI: 10.1016/j.colsurfb.2022.112332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 01/09/2023]
Abstract
Bacterial adhesion and bile sludge accumulation can increase the risk of complications such as stent restenosis after biliary stent implantation. Compared with active and passive antimicrobial surfaces, a significant advantage of slippery liquid-infused porous surfaces (SLIPSs) is their recoverable anti-adhesive properties. According to the mechanism of SLIPSs and the application environments of the biliary system, a polytetrafluoroethylene (PTFE) electrospun fibrous membrane-impregnated silicone-oil system was developed to construct an ultrasmooth surface. Experimental results indicated that a PTFE SLIPS with 350 cSt of silicone oil had an extremely small roll angle (< 5°) and a high slip rate (4.8 ± 0.1 mm/s) and maintained excellent sliding stability after 7 d of immersion in model bile system. Thus, it can inhibit the adhesion of proteins, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, and bile sludge. Moreover, when human fibroblasts were cultured on the PTFE SLIPS, it exhibited good cytocompatibility. Therefore, the proposed ultrasmooth PTFE membranes provide a promising alternative for biliary system to prevent bacterial adhesion and bile sludge accumulation.
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Affiliation(s)
- Zhang Yu
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China
| | - Sun Yu
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Liu Laijun
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China; Engineering Research Center of Technical Textiles, Ministry of Education, Donghua University, Shanghai 201620, China
| | - Liu Wenjing
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China
| | - Li Chaojing
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China; Engineering Research Center of Technical Textiles, Ministry of Education, Donghua University, Shanghai 201620, China
| | - Jiang Hong
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China.
| | - Wang Fujun
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China; Engineering Research Center of Technical Textiles, Ministry of Education, Donghua University, Shanghai 201620, China.
| | - Wang Lu
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China; Engineering Research Center of Technical Textiles, Ministry of Education, Donghua University, Shanghai 201620, China
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Lam R, Muniraj T. Fully covered metal biliary stents: A review of the literature. World J Gastroenterol 2021; 27:6357-6373. [PMID: 34720527 PMCID: PMC8517778 DOI: 10.3748/wjg.v27.i38.6357] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Fully covered self-expandable metal stents (FCSEMS) represent the latest advancement of metal biliary stents used to endoscopically treat a variety of obstructive biliary pathology. A large stent diameter and synthetic covering over the tubular mesh prolong stent patency and reduce risk for tissue hyperplasia and tumor ingrowth. Additionally, FCSEMS can be easily removed. All these features address issues faced by plastic and uncovered metal stents. The purpose of this paper is to comprehensively review the application of FCSEMS in benign and malignant biliary strictures, biliary leak, and post-sphincterotomy bleeding.
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Affiliation(s)
- Robert Lam
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Thiruvengadam Muniraj
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, United States
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Toyokawa Y, Kobayashi S, Tsuchiya H, Shibuya T, Aoki M, Sumiya J, Ooyama S, Ishizawa T, Makino N, Ueno Y, Tanaka M. A fully covered self-expandable metallic stent coated with poly (2-methoxyethyl acrylate) and its derivative: In vitro evaluation of early-stage biliary sludge formation inhibition. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 120:111386. [PMID: 33545807 DOI: 10.1016/j.msec.2020.111386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 01/02/2023]
Abstract
The adhesion and deformation behavior of proteins at the inner surface of fully covered, self-expandable metallic stents coated with biocompatible polymers, poly(2-methoxyethyl acrylate) (PMEA) and poly(3-methoxypropyl acrylate) (PMC3A), were analyzed. Model bile solution, proteins, and bacteria were used to unravel the inhibitory ability of the polymer coatings. Adsorbance of proteins and adherence of bacteria were both strongly inhibited by the polymer coatings. Circulation tests were performed under clinical conditions using human bile from patients. Adsorption/deformation of proteins and early-stage sludge formation were inhibited on stent surfaces coated with PMEA derivatives. The present study revealed that early-stage biliary sludge formation on PMEA- and PMC3A-coated stents was suppressed due to the strong resistance of the polymers to protein adsorption/deformation, brought about by intermediate water in hydrated polymer coatings, which is not present in conventional coating materials, such as silicone and polyurethane.
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Affiliation(s)
- Yoshihide Toyokawa
- Former Piolax Medical Devices, Inc., 2265-3 Kamiyabe-Cho, Totsuka-Ku, Yokohama-Shi, Kanagawa 245-0053, Japan
| | - Shingo Kobayashi
- Soft Materials Chemistry, Institute for Materials Chemistry and Engineering, Kyushu University, Build. CE41, 744 Motooka Nishi-ku, Fukuoka 819-0395, Japan
| | - Haruka Tsuchiya
- Former Frontier Center for Organic Materials, Yamagata University, 4-3-16 Jonan, Yonezawa, Yamagata 992-8510, Japan
| | - Tomokazu Shibuya
- Former Frontier Center for Organic Materials, Yamagata University, 4-3-16 Jonan, Yonezawa, Yamagata 992-8510, Japan
| | - Makiko Aoki
- Former Piolax Medical Devices, Inc., 2265-3 Kamiyabe-Cho, Totsuka-Ku, Yokohama-Shi, Kanagawa 245-0053, Japan
| | - Jun Sumiya
- Piolax Medical Devices, Inc., 2265-3 Kamiyabe-Cho, Totsuka-Ku, Yokohama-Shi, Kanagawa 245-0053, Japan
| | - Shun Ooyama
- Piolax Medical Devices, Inc., 2265-3 Kamiyabe-Cho, Totsuka-Ku, Yokohama-Shi, Kanagawa 245-0053, Japan
| | - Tetsuya Ishizawa
- Yamagata University School of Medicine, Course of Internal Medicine and Therapeutics, Department of Gastroenterology and Division of Endoscopy, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Naohiko Makino
- Yamagata University School of Medicine, Course of Internal Medicine and Therapeutics, Department of Gastroenterology and Division of Endoscopy, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Yoshiyuki Ueno
- Yamagata University School of Medicine, Course of Internal Medicine and Therapeutics, Department of Gastroenterology and Division of Endoscopy, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Masaru Tanaka
- Soft Materials Chemistry, Institute for Materials Chemistry and Engineering, Kyushu University, Build. CE41, 744 Motooka Nishi-ku, Fukuoka 819-0395, Japan; Former Frontier Center for Organic Materials, Yamagata University, 4-3-16 Jonan, Yonezawa, Yamagata 992-8510, Japan.
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7
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Safety and efficacy of a metal stent covered with a silicone membrane containing integrated silver particles in preventing biofilm and sludge formation in endoscopic drainage of malignant biliary obstruction: a phase 2 pilot study. Gastrointest Endosc 2019; 90:663-672.e2. [PMID: 31220446 DOI: 10.1016/j.gie.2019.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Membrane-covered self-expandable metal stents (SEMSs) have been developed to prolong the patency of stents by reducing tissue hyperplasia or tumor ingrowth. However, their effectiveness is attenuated by stent clogging as a result of biofilm formation on the inner surface of the membrane. The aim of this pilot study was to evaluate the efficacy and safety of SEMSs covered with a silicone membrane containing integrated silver particles (Ag-P) in malignant distal biliary obstruction. METHODS Twenty-four patients who underwent SEMS placement because of malignant distal biliary obstruction were enrolled in this single-center pilot study. The main outcomes were technical success, clinical success, adverse events, stent patency, and survival. RESULTS The technical and clinical success rates were 100% and 91.7% (22 of 24), respectively. The rates of early and late adverse events were 22.7% and 36.4%, respectively. The primary reintervention rate was 27.3% (6 of 22). Only 1 case involving stent malfunction was associated with sludge impaction. Median stent patency was 179 days. During follow-up, there were no serious adverse events or mortality related to the stents or Ag-P. Serum and urine silver concentrations before and after stent placement and at 32 weeks after placement did not differ. All serum and urine silver concentrations were <3 μg/L (3 ppb) and 5 μg/L (5 ppb), respectively. CONCLUSIONS SEMSs covered with a silicone membrane containing integrated Ag-Ps may be effective and safe in malignant distal biliary obstruction. Stent dysfunction related to sludge impaction may be less frequent using this new stent. (Clinical Research Information Service identifier: KCT 0002310.).
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Ramasamy M, Lee J. Recent Nanotechnology Approaches for Prevention and Treatment of Biofilm-Associated Infections on Medical Devices. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1851242. [PMID: 27872845 PMCID: PMC5107826 DOI: 10.1155/2016/1851242] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/13/2016] [Indexed: 11/23/2022]
Abstract
Bacterial colonization in the form of biofilms on surfaces causes persistent infections and is an issue of considerable concern to healthcare providers. There is an urgent need for novel antimicrobial or antibiofilm surfaces and biomedical devices that provide protection against biofilm formation and planktonic pathogens, including antibiotic resistant strains. In this context, recent developments in the material science and engineering fields and steady progress in the nanotechnology field have created opportunities to design new biomaterials and surfaces with anti-infective, antifouling, bactericidal, and antibiofilm properties. Here we review a number of the recently developed nanotechnology-based biomaterials and explain underlying strategies used to make antibiofilm surfaces.
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Affiliation(s)
| | - Jintae Lee
- School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Lee TH, Jang BS, Jung MK, Pack CG, Choi JH, Park DH. Fabrication of a silver particle-integrated silicone polymer-covered metal stent against sludge and biofilm formation and stent-induced tissue inflammation. Sci Rep 2016; 6:35446. [PMID: 27739486 PMCID: PMC5064322 DOI: 10.1038/srep35446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/29/2016] [Indexed: 12/19/2022] Open
Abstract
To reduce tissue or tumor ingrowth, covered self-expandable metal stents (SEMSs) have been developed. The effectiveness of covered SEMSs may be attenuated by sludge or stone formation or by stent clogging due to the formation of biofilm on the covering membrane. In this study, we tested the hypothesis that a silicone membrane containing silver particles (Ag-P) would prevent sludge and biofilm formation on the covered SEMS. In vitro, the Ag-P-integrated silicone polymer-covered membrane exhibited sustained antibacterial activity, and there was no definite release of silver ions from the Ag-P-integrated silicone polymer membrane at any time point. Using a porcine stent model, in vivo analysis demonstrated that the Ag-P-integrated silicone polymer-covered SEMS reduced the thickness of the biofilm and the quantity of sludge formed, compared with a conventional silicone-covered SEMS. In vivo, the release of silver ions from an Ag-P-integrated silicone polymer-covered SEMS was not detected in porcine serum. The Ag-P-integrated silicone polymer-covered SEMS also resulted in significantly less stent-related bile duct and subepithelium tissue inflammation than a conventional silicone polymer-covered SEMS. Therefore, the Ag-P-integrated silicone polymer-covered SEMS reduced sludge and biofilm formation and stent-induced pathological changes in tissue. This novel SEMS may prolong the stent patency in clinical application.
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Affiliation(s)
- Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Bong Seok Jang
- R&D Institute of Intervention, M. I. Tech Co., Ltd., 174 Habuk 2gil, Jinwi-myeon, Pyeongtaek, Gyeonggi-do, 451-864, South Korea
| | - Min Kyo Jung
- Department of Convergence Medicine, University of Ulsan College of Medicine &Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.,School of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | - Chan Gi Pack
- Department of Convergence Medicine, University of Ulsan College of Medicine &Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Jun-Ho Choi
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, South Korea
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Vuotto C, Donelli G. Anaerobes in Biofilm-Based Healthcare-Associated Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:97-112. [DOI: 10.1007/978-3-319-11038-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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In vivo and in situ evaluation of a wireless magnetoelastic sensor array for plastic biliary stent monitoring. Biomed Microdevices 2014; 15:509-17. [PMID: 23460136 DOI: 10.1007/s10544-013-9750-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This paper presents the in vivo and in situ evaluation of a system that wirelessly monitors the accumulation of biliary sludge in a plastic biliary stent. The sensing element, located within the stent, is a passive array of magnetoelastic resonators that is queried by a wireless electromagnetic signal. The in vivo and in situ testing uses commercially-available plastic biliary stents, each enhanced with an array of ribbon sensors (formed from Metglas™ 2826 MB). The sensor array is approximately 70 mm long and contains individual resonators that are 1 mm in width and have lengths of 10 mm, 14 mm, and 20 mm. The array is anchored into the 2.8 mm inner-diameter stent using a thermal staking technique. For the in situ testing, an instrumented stent is placed in various locations within the abdominal cavity of a female domestic swine carcass to evaluate the wireless range of the system; these results show that a wireless signal can be obtained from a range of at least 7.5 cm from a sensor array covered in bile. The in vivo testing includes the endoscopic implantation of an instrumented stent into the bile duct of a swine. After implantation, the swine was housed for a period of 4 weeks, during which the animal showed no ill effects and followed the expected growth curve from 29 kg to 42 kg. At the conclusion of the in vivo test, the animal was euthanized, and the instrumented stent explanted and examined. The results presented in this paper indicate that the monitoring system does not adversely affect the health of the animal and can feasibly provide sufficient wireless range after implantation.
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13
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Green SR, Kwon RS, Elta GH, Gianchandani YB. In situ and ex vivo evaluation of a wireless magnetoelastic biliary stent monitoring system. Biomed Microdevices 2010; 12:477-84. [PMID: 20180152 DOI: 10.1007/s10544-010-9404-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper presents the in situ and ex vivo evaluation of a system that wirelessly monitors the accumulation of intimal tissue and sludge in a biliary stent. The sensing element, located within the stent, is a magnetoelastic resonator that is queried by a wireless radio frequency signal. The in situ testing uses a commercially-available self-expanding biliary stent enhanced with a 1 mm x 25 mm magnetoelastic ribbon sensor (formed from Metglas 2605SA1). The stent has a conformal magnetic layer (consisting of strontium ferrite particles suspended in polydimethylsiloxane) that biases the sensor. The external interrogation module is able to acquire a signal from the sensor from a distance of at least 5 cm while the sensor is implanted in a porcine carcass and loaded with biological fluids. The ex vivo testing uses bile harvested from the porcine carcass. The response of a 1 mm x 25 mm magnetoelastic ribbon sensor is first calibrated with fluids of known density and viscosity, and the calibrated sensor is used to estimate that the viscosity of the harvested bile is 2.7-3.7 cP. The test results presented in this paper illustrate the fundamental usability of the system when the sensor is implanted, loaded by biological fluids, and interrogated in a surgical setup.
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Affiliation(s)
- Scott Ryan Green
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.
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14
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Characterization of the complex bacterial communities colonizing biliary stents reveals a host-dependent diversity. ISME JOURNAL 2009; 3:797-807. [PMID: 19360025 DOI: 10.1038/ismej.2009.36] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study provides a comprehensive survey of the spatial and temporal bacterial composition of biliary stent biofilms. The bacterial diversity, distribution and dynamics of 59 biliary and 4 pancreatic stent communities from 40 patients being treated at two different hospitals, which implant stents either simultaneously or consecutively, were characterized by single-strand conformation polymorphism (SSCP) analysis. Fifty-one phylotypes belonging to 5 bacterial phyla and 24 bacterial families were detected across 63 stents. This is a much broader diversity than previously detected through culture-dependent methods, particularly in regard to the diversity of obligate anaerobes. Stent bacterial diversity was patient-dependent and more similar when stents were implanted simultaneously rather than consecutively. Stent bacterial community composition differed between hospitals specifically because of the difference in abundance of Bifidobacteria. Co-colonization of Veillonella sp., Streptococcus anginosus and organisms closely related to Fusobacterium nucleatum revealed a potentially important attachment and survival strategy that has yet to be reported in biliary stents. This work reveals a more complete survey of the identities of bacterial species that form biofilms in biliary stents, their co-colonization patterns and the natural variation in species composition between different patients, hospitals and locations along the stent. Consideration of the community composition from individual patients will allow tailoring of prophylactic antibiotic treatments and thus will make the management of stent biofilms more effective.
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Unlu RE, Yilmaz AD, Orbay H, Can B, Tekdemir I, Sensoz O. Influence of rifampin on capsule formation around silicone implants in a rat model. Aesthetic Plast Surg 2007; 31:358-64. [PMID: 17551775 DOI: 10.1007/s00266-006-0248-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the effect of rifampin on the thickness of capsules around silicone implants by bactericidal activity against Stapylococcus epidermidis. Silicone blocks (1 x 1 cm) were placed into pockets created for each of the 40 rats included in the study. In group 1, the operation was performed under aseptic conditions. In group 2, standard S. epidermidis was inoculated into the pocket, whereas rifampin and S. epidermidis were applied in group 3. In group 4, only rifampin was applied topically on implants. After 12 weeks, the peri-implant capsules were removed and examined under a photomicroscope and a scanning electron microscope. The mean thickness of the capsules was 63.307 microm in group 1, 111.538 microm in group 2, 43.076 microm in group 3, and 30.384 mum in group 4. The differences between groups 2 and 3 and groups 2 and 4 were found to be statistically significant (p < 0.001). Rifampin appears to be an agent for preventing peri-implant capsule formation.
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Affiliation(s)
- Ramazan Erkin Unlu
- Department of 2nd Plastic and Reconstructive Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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16
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Pajkos A, Deva AK, Vickery K, Cope C, Chang L, Cossart YE. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 2003; 111:1605-11. [PMID: 12655204 DOI: 10.1097/01.prs.0000054768.14922.44] [Citation(s) in RCA: 267] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The pathogenesis of fibrous capsular contracture after augmentation mammaplasty is still debated. One hypothesis implicates low-grade bacterial infections as a cause. The presence of a staphylococcal biofilm in a patient with recurrent capsular contracture was previously reported. A comparative, prospective, blinded, clinical study of implants and capsules removed from patients with or without significant capsular contracture was conducted to investigate the association of biofilm contamination, breast implants, and capsular contracture. Capsule and implant samples obtained during explantation were tested by routine microbiological culture, sensitive broth culture (after maceration and sonication), and scanning electron microscopy. Clinical parameters were correlated with microbiological findings. A total of 48 implant and/or capsule samples were obtained from 27 breasts during a 22-month period. Of the 27 breasts, 19 exhibited significant contracture (Baker grade III/IV). The mean duration of implantation was 9.2 years (range, 0.4 to 26.0 years). Routine swab cultures obtained at the time of explantation were negative for bacterial growth for all samples. The sensitive broth culture technique yielded 24 positive samples (50 percent, n = 48). An analysis of capsules demonstrated that 17 of 19 samples obtained from patients with significant contracture were positive, compared with only one of eight samples obtained from patients with minimal or no contracture (p = 0.0006). Fourteen of the 17 positive cultures from significantly contracted breasts yielded coagulase-negative staphylococci, mainly, species of the Staphylococcus epidermidis group. The presence of coagulase-negative staphylococci was also significantly associated with capsular contracture (p = 0.01). There was no significant difference in the frequency of culture positivity for saline versus silicone implants (p = 0.885). Scanning electron microscopy confirmed the presence of extensive biofilm on implants and within capsules.Biofilm, in particular, S. epidermidis biofilm, was detected for a significant proportion of patients with capsular contracture. This implicates biofilm disease in the pathogenesis of contracture, and strategies for its prevention should be explored.
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Affiliation(s)
- Aniko Pajkos
- Department of Infectious Diseases, University of Sydney, Australia
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Schierholz JM, Beuth J, König D, Nürnberger A, Pulverer G. Antimicrobial substances and effects on sessile bacteria. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1999; 289:165-77. [PMID: 10360317 DOI: 10.1016/s0934-8840(99)80101-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Biofilms occur in natural aquatic ecosystems and on surfaces of biomaterials. They are generally associated with clinical infections predominantly of prosthetic hip joints, heart valves and catheters. Sessile microorganisms may be intimately associated with each other and to solid substratum through binding to and inclusion into exopolymer matrices on biofilms. The establishment of functional colonies within the exopolymeric matrices generate physico-chemical gradients within biofilms, that modify the metabolism and cell-wall properties of the microorganism. A consequence of biofilm growth is an enhanced microbial resistance to chemical antimicrobial agents and antibiotics. Investigations on the antimicrobial efficacy of antibiotics, antiseptics and antimicrobial heavy ions, however, gave controversial results. No single antimicrobial substance has been developed for the efficient eradication of adherent bacteria. This review elucidates the mechanisms of microbial resistance in biofilms and strategies for the prevention of biofilm development. Pharmacokinetical and pharmacodynamical issues for the screening of biofilm-active drugs are presented. Combinations of antistaphylococcal antibiotics with rifampin may be advantageous for preventing and curing biomaterial infections.
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Affiliation(s)
- J M Schierholz
- Institute for Medical Microbiology and Hygiene, University of Cologne, Germany
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