In vitro study of the efficacy of acrylic bone cement loaded with supplementary amounts of gentamicin: Effect on mechanical properties, antibiotic release, and biofilm formation

Background: Infection remains a severe complication following a total hip replacement. If infection is suspected when revision surgery is being performed, additional gentamicin is often added to the cement on an ad hoc basis in an attempt to reduce the risk of recurrent infection.

Methods and results: In this in vitro study, we determined the effect of incorporating additional gentamicin on the mechanical properties of cement. We also determined the degree of gentamicin release from cement, and also the extent to which biofilms of clinical Staphylococcus spp. isolates form on cement in vitro. When gentamicin was added to unloaded cement (1–4 g), there was a significant reduction in the mechanical performance of the loaded cements compared to unloaded cement. A significant increase in gentamicin release from the cement over 72 h was apparent, with the amount of gentamicin released increasing significantly with each additional 1 g of gentamicin added. When overt infection was modeled, the incorporation of additional gentamicin did result in an initial reduction in bacterial colonization, but this beneficial effect was no longer apparent by 72 h, with the clinical strains forming biofilms on the cements despite the release of high levels of gentamicin.

Interpretation: Our findings indicate that the addition of large amounts of gentamicin to cement is unlikely to eradicate bacteria present as a result of an overt infection of an existing implant, and could result in failure of the prosthetic joint because of a reduction in mechanical performance of the bone cement.

Paracetamol-Loaded Poly(ε-caprolactone) Layered Silicate Nanocomposites

The work described in this paper demonstrates a combined novel approach to the preparation of drug loaded poly(e-caprolactone) layered silicate nanocomposites using hot melt extrusion, a continuous process in contrast to the normal batch type processing used to prepare polymeric drug delivery systems, and most significantly the use of high surface area, large aspect ratio inorganic nanoplatelets to retard drug release. The methodology and results described in this article are significant and could equally be applied to the controlled/retarded release of any bio-active molecule (pharmaceutical, nutraceutical, protein, DNA/iRNA, anti-microbial, anti-coagulant, etc.) from biopolymers and the production of medical devices from such composite materials.

Clinical and immunohistochemical assessment of vulval intraepithelial neoplasia following photodynamic therapy using a novel bioadhesive patch-type system loaded with 5-aminolevulinic acid

Background: The work in this study appraised photodynamic treatment (PDT) as a treatment method for vulval intraepithelial neoplasia (VIN) using a novel bioadhesive patch to deliver aminolevulinic acid. An analysis of changes in expression of apoptotic and cell cycle proteins (p53, p21, Mdm2, Blc-2, Bax, Ki-67) in response to PDT was evaluated. Methods: PDT was performed using non-laser light, either as a one or two-cycle treatment, with clinical and pathological assessment following after 6 weeks. Twenty-three patients with 25 VIN lesions underwent 49 cycles of PDT Patches were designed to conform to uneven vulval skin and contained 38 mg cm(-2) aminolevulinic acid. Assessment was carried out at 6 weeks post-treatment. Patient-based treatment assessment, along with clinical and pathological changes, were monitored. Immunohistochemical staining was used to elucidate a possible biomolecular basis for induced cellular changes. Results: Most patients (52%) reported a symptomatic response, with normal pathology restored in 38% of lesions. The patch was easy to apply and remove, causing minimal discomfort. Fluorescence inspection confirmed protoporphyrin accumulation. Pain during implementation of PDT was problematic, necessitating some form of local analgesia. Changes in expression of cell cycle and apoptotic-related proteins suggested involvement of apoptotic pathways. Down regulation of p21 and inverse changes in Bcl-2 and Bax were key findings. Conclusion: Treatment of VIN lesions using a novel bioadhesive patch induced changes in cell cycle and apoptotic proteins in response to PDT with possible utilisation of apoptotic pathways. The efficacy of PDT in treating VIN could be improved by a better understanding of these apoptotic mechanisms, the influence of factors, such as HPV status, and of the need for effective pain management.

Influence of Formulation Factors on PpIX Production and Photodynamic Action of Novel ALA-loaded Microparticles

A novel 5-aminolevulinic acid (ALA)-containing microparticulate system was produced recently, based on incorporation of ALA into particles prepared from a suppository base that maintains drug stability during storage and melts at skin temperature to release its drug payload. The novel particulate system was applied to the skin of living animals, followed by study of protoporphyrin IX (PpIX) production. The effect of formulating the microparticles in different vehicles was investigated and also the phototoxicity of the PpIX produced using a model tumour. Particles formulated in propylene glycol gels (10% w/w ALA loading) generated the highest peak PpIX fluorescence levels in normal mouse skin. Peak PpIX levels induced in skin overlying subcutaneously implanted WiDr tumours were significantly lower than in normal skin for both the 10% w/w ALA microparticles alone and the 10% w/w ALA microparticles in propylene glycol gels during continuous 12 h applications. Tumours not treated with photodynamic therapy continued to grow over the 17 days of the anti-tumour study. However, those treated with 12 h applications of either the 10% w/w ALA microparticles alone or the 10% w/w ALA microparticles in propylene glycol gel followed by a single laser irradiation showed no growth. The gel formulation performed slightly better once again, reducing the tumour growth rate by approximately 105%, compared with the 89% reduction achieved using particles alone. Following the promising results obtained in this study, work is now going on to prepare particle-loaded gels under GMP conditions with the aim of initiating an exploratory clinical trial.

Periodically loaded dipole array supporting left-handed propagation

Periodically loaded dipole arrays printed on grounded dielectric substrate are shown to exhibit left-handed propagation properties. In an equivalent transmission line representation, lefthandedness emerges due to the excess series capacitance and shunt inductance. Based on this concept, the authors study the distribution of the modal fields and the variation of series capacitance and shunt inductance as the dipoles are loaded with stubs. Full wave dispersion curves that show the gradual transition from a right-handed to a left-handed medium upon periodically loading the dipoles with stubs are presented. An equivalent circuit is derived that matches to a very good extent the full wave result. The cell dimensions are a small fraction of the wavelength (),15), so the structure can be considered as an equivalent homogeneous surface. The structure is simple, readily scalable to higher frequencies and compatible with low-cost fabrication techniques.

Periodically loaded 1-D metallodielectric electromagnetic bandgap structures for miniaturisation and bandwidth enhancement

Periodic loading of 1-D metallodielectric electromagnetic bandgap (MEBG) structures has been rigorously investigated. Miniaturised and broadband MEBG structures have been produced by means of periodically loading a dipole array. A study has been carried out with regard to the loading mechanism, the number of stubs, the topology of the structure and the order of loading. Simulations have been carried out using a method of moments based software. First order uniform loading stubs have yielded a significant size reduction of the MEBG array and the bandwidth has doubled. Good agreement between simulations and measurements has been achieved. The current distribution on the proposed structure has been studied, yielding valuable insight. An interdigital topology has resulted in further miniaturisation and bandwidth enhancement. Fractal-type arrays have been produced after applying second order loading. A maximum miniaturisation of 2.5:1 has been achieved.

Novel periodically loaded E-plane filters

Novel E-plane waveguide filters with periodically loaded resonators are proposed. The proposed filters make use of the slow wave effect in order to achieve improved stopband performance and size reduction of roughly 50% without introducing any complexity in the fabrication process. Numerical and experimental results are presented to validate the argument.

Novel periodically loaded ridged waveguide resonators

Novel periodically loaded E-plane waveguide resonators are presented in this paper. The proposed resonators make use of the slow-wave effect in order to achieve significantly increased loaded Q values for resonators of constant volume, as compared to their homogeneous counterparts, without introducing any complexity in the fabrication process. Numerical and experimental results are presented to validate the argument. (C) 2003 Wiley Periodicals, Inc.

Novel periodically loaded multilayer resonators

In this paper novel 3D periodic multilayer structures are investigated in MIC technology, and a periodically loaded multilayer waveguide resonant structure is proposed. This is a very compact structure and still maintains simple fabrication process. The resonator is designed at 10 and 28 GHz. The simulated results of this resonator, which is obtained from commercial FEM software package HFSS, are confirmed by experimental results. The experiments are based oil the same resonator structure, only at 10 GHz. By modifying the conventional waveguide resonator, with the proposed structure, a minimum 30% shorter resonator can be achieved, which is very important at filter applications. (C) 2002 Wiley Periodicals, Inc.

Characterisation of microwave phase conjugate signal generation using nonlinearly loaded wire frequency selective surface (FSS)

Both experimental and theoretical information regarding the scattering and phase conjugate mixing properties of a 2D double-periodic array of wires loaded with nonlinear/linear lumped elements have been provided. An experimental means for assessing the phase conjugate energy production capability for the array is given. These investigations enable identification of the fundamental operational characteristics and underlying mechanisms associated with the production of phase conjugate energy by this type of artificial electromagnetic media. Means for enhancing the phase conjugate energy production capability of the structure by using additional linear lumped loads is examined theoretically and limits on the production of phase conjugate energy established. Theoretical far-field prediction of the behaviour of the structure indicates that retro-directive reflector action as well as negative refraction should be possible.