Adrian Reśliński

Activity of metalloproteinases and adiponectin in obese patients— a possible factor of incisional hernias after bariatric procedures

PurposeMetalloproteinases are a key component of the pathogenesis of abdominal hernias. Obesity is considered a risk factor in herniogenesis and hernia recurrence. The aim of this study was to evaluate the serum concentrations of metalloproteinase-2 (MMP-2), MMP-9, MMP-13, and adiponectin in morbidly obese and nonoverweight controls.Materials and methodsThe participants were recruited from among patients undergoing bariatric and non-bariatric surgery and divided into two groups: I (body mass index (BMI)≥35 kg/m2, n=40) and II (BMI<25 kg/m2, n=30). Serum concentrations of MMP-2, MMP-9, MMP-13, and adiponectin were measured using enzyme-linked immunosorbent assay (ELISA).ResultsA statistically significant difference between groups was observed for MMP-2 concentration. The median MMP-9 concentration was higher in the obese group, but the difference was not statistically significant. Median MMP-13 concentrations did not differ between groups. Serum adiponectin concentration was insignificantly higher in the non-obese group.ConclusionsThe elevated serum MMP-2 and MMP-9 concentrations in obese individuals may be related to the higher incidence of incisional hernias in this population.摘要目的主要研究病态肥胖患者与正常人血清中金属蛋白 酶2(MMP-2)、MMP-9、MMP-13 和脂联素的 浓度。创新点建立血清中MMP-2、MMP-9、MMP-13 和脂联 素的浓度与肥胖和切口疝的关系。方法参与实验的人员为进行肥胖手术的患者和不进行 肥胖手术的患者,并将他们分为两组:I(体重 指数(BMI)≥35 kg/m2,n=40)和II (BMIlt;25 kg/m2, n=30),并使用酶联免疫吸附实验测定受试人员 体内血清中MMP-2、MMP-9、MMP-13 和脂联 素的浓度。结论MMP-2 的浓度在肥胖组中更高,且在两组血清 中有显著性差异。虽然MMP-9 的浓度在肥胖组 中更高,但是两组之间没有显著性差异。MMP-13 在两组间没有差异。血清中脂联素的浓度在非肥 胖组更高,但无显著性差异。因此,血清中 MMP-2和MMP-9的浓度在肥胖人群中与更高的 切口疝发病率有关。

Biofilm formation on biomaterials used in hernia surgery

Deep surgical site infection (DSSI) in patients undergoing hernioplasty with implantation of biomaterials is a complication taking place with biofilm formation. Despite the indicated increase in the frequency of isolation of S. aureus and E. coli bacteria as etiological factors of DSSI, there have been few studies published so far that evaluated biofilm formation by these microorganisms on the surface of different biomaterials. The aim of this study was to evaluate and compare biofilm formation on the surface of biomaterials used in hernia surgery by clinical isolates of S. aureus and E. coli. 70 strains of S. aureus and E. coli were used; they differed in chromosomal DNA within the species. The evaluation of biofilm formation on the surface of the monofilament polypropylene mesh, multifilament mesh (polypropylene, polyester and composite) and a patch of expanded polytetrafluoroethylene was made using qualitative and quantitative methods and by means of a scanning electron microscope. The strains differ in terms of biofilm formation within the species. Strains of S. aureus formed a biofilm more strongly than E. coli. The investigated strains formed biofilm stronger on the surface of the multifilament implants than on polypropylene monofilament mesh. Formation of biofilm by clinical isolates of S. aureus and E. coli on the surface of biomaterials used in hernia surgery varies depending on the strain and species of bacteria as well as the structure and the hydrophobicity of biomaterial.

Asymptomatic infection of a surgical mesh implant

Zakazenie obejmujące implantat jest jednym z najpowazniejszych powiklan towarzyszących stosowaniu biomaterialow w chirurgii przepuklin. Zakazenie implantatu moze miec rozny przebieg kliniczny. W pracy przedstawiono przypadek bezobjawowego zakazenia siatki chirurgicznej zastosowanej do zaopatrzenia przepukliny okolopepkowej. Zakazenie zostalo rozpoznane przypadkowo podczas operacji z powodu nawrotu przepukliny. Badania metodą jakościową z uzyciem chlorku 2,3,5-trojfenylotetrazoliowego (TTC), metodą ilościową oraz z uzyciem skaningowego mikroskopu elektronowego wykazaly obecnośc biofilmu bakteryjnego na powierzchni implantatu zastosowanego do pierwotnego zaopatrzenia przepukliny. Jego obecnośc na powierzchni implantatu uchronila drobnoustroje przez dzialaniem ukladu odpornościowego pacjenta i byla odpowiedzialna za bezobjawowy przebieg zakazenia biomaterialu. Zdaniem autorow wszystkie implantaty usuwane podczas operacji z powodu nawrotu przepukliny nalezy poddac badaniu mikrobiologicznemu, nawet gdy nie stwierdza sie makroskopowych cech zakazenia. Do badan diagnostycznych powinna zostac wlączona metoda redukcji TTC, co pozwala ograniczyc liczbe wynikow falszywie ujemnych.