A PEDOT nano-composite for hyperthermia and elimination of urological bacteria.

Novel modalities for overcoming recurrent urinary tract infections associated with indwelling urinary catheters are needed, and rapidly induced hyperthermia is one potential solution. PEDOT nanotubes are a class of photothermal particles that can easily be incorporated into silicone to produce thin, uniform coating on medical grade silicone catheters; subsequent laser stimulation therein imparts temperature elevations that can eliminate bacteria and biofilms. PEDOT silicone coatings are stable following thermal sterilization and repeated heating and cooling cycles. Laser stimulation can induce temperature increases of up to 55 °C in 300 s, but only 45 s was needed for ablation of UTI inducing E. coli biofilms in vitro. This work also demonstrates that mild hyperthermia of 50 °C, applied for only 31 s in the presence of antibiotics could eliminate E. coli biofilm as effectively as high temperatures. This work culminates in the evaluation of the PEDOT NTs for photothermal elimination of E. coli in an in vivo model to demonstrate the safety and effectiveness of a photothermal nanocomposite (16 s treatment time) for rapid clearance of E. coli.

Endovascular Perfusion Augmentation for Critical Care Decreases Vasopressor Requirements while Maintaining Renal Perfusion.

BACKGROUND: Ischemia reperfusion injury causes a profound hyperdynamic distributive shock. Endovascular perfusion augmentation for critical care (EPACC) has emerged as a hemodynamic adjunct to vasopressors and crystalloid. The objective of this study was to examine varying levels of mechanical support for the treatment of ischemiareperfusion injury in swine. METHODS: Fifteen swine underwent anesthesia and then a controlled 30% blood volume hemorrhage followed by 30 min of supra-celiac aortic occlusion to create an ischemia-reperfusion injury Animals were randomized to standardized critical care (SCC), EPACC with low threshold (EPACC-Low), and EPACC with high threshold (EPACC-High). The intervention phase lasted 270 min after injury Hemodynamic markers and laboratory values of ischemia were recorded. RESULTS: During the intervention phase, SCC spent 82.4% of the time avoiding proximal hypotension (>60 mm Hg), while EPACC-Low spent 97.6% and EPACC-High spent 99.5% of the time avoiding proximal hypotension, P  < 0.001. Renal artery flow was statistically increased in EPACC-Low compared with SCC (2.29 mL/min/kg vs. 1.77 mL/ min/kg, P  < 0.001), while renal flow for EPACC-High was statistically decreased compared with SCC (1.25 mL/min/kg vs. 1.77 mL/min/kg, P  < 0.001). EPACC animals required less intravenous norepinephrine, (EPACC-Low: 16.23mcg/kg and EPACC-High: 13.72 mcg/kg), compared with SCC (59.45 mcg/kg), P = 0.049 and P = 0.013 respectively. CONCLUSIONS: Compared with SCC, EPACC-High and EPACC-Low had decreased norepinephrine requirements with decreased frequency of proximal hypotension. EPACC-Low paradoxically had increased renal perfusion despite having a mechanical resistor in the aorta proximal to the renal arteries. This is the first description of low volume mechanical hemodynamic support in the setting of profound shock from ischemia-reperfusion injury in swine demonstrating stabilized proximal hemodynamics and augmented distal perfusion.

Hematoma Risks of Nonsteroidal Anti-inflammatory Drugs Used in Plastic Surgery Procedures: A Systematic Review and Meta-analysis.

BACKGROUND: The opioid crisis in America has sparked a shift toward a multimodality perioperative pain regimen. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative period decreases opioid consumption and increases efficacy. However, many plastic surgeons avoid their use because of antiplatelet effects. The purpose of this article is to systematically review the plastic surgery literature to assess the risk of intraoperative or postoperative bleeding and hematoma formation. METHODS: A systematic review of articles published in PubMed was performed in September 2018 to investigate the incidence of increased bleeding and hematoma formation with use of NSAIDs in the perioperative period in plastic surgery. All articles were reviewed for primary outcome measures, and a selective literature review was performed to examine perioperative NSAID use in other surgical subspecialties. Random-effect meta-analysis was performed. RESULTS: Our search yielded 806 total articles, with 15 meeting inclusion criteria, and this included 3064 patients (1679 with perioperative NSAIDs, 1385 with no NSAIDs). There was no significant difference in overall incidence of bleeding/hematoma in the treatment group versus control (no NSAIDs). The overall pooled odds ratio (OR) and corresponding 95% confidence interval were 1.20 and 0.73 to 1.97 (P = 0.48). When separated by drug administered across all plastic surgery procedures, there were no statistically significant differences in incidences of hematoma or increased bleeding with use of ketorolac (OR, 1.48 [0.86-2.56]; P = 0.57), ibuprofen (OR, 0.55 [0.14-2.14]; P = 0.87), or celecoxib (OR, 0.22 [0.02-2.52]; P = 0.39). When examining NSAID use in breast surgery, there was no statistically significant difference in incidence of hematoma or increased bleeding when combining all 3 drug types (OR, 1.39 [0.82-2.37]; P = 0.60). Some individual studies demonstrated trends toward increased bleeding/hematoma in reduction mammoplasties. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs significantly improve pain control and decrease opioid use when used in plastic surgery. The majority of evidence in plastic surgery does not support an increased incidence of bleeding/hematoma with the use of perioperative NSAIDs.