The Experts below are selected from a list of 165 Experts worldwide ranked by ideXlab platform
Howard Y. Park - One of the best experts on this subject based on the ideXlab platform.
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progress not panacea vancomycin powder efficacy and dose evaluated in an in vivo mouse model of Spine Implant infection
The Spine Journal, 2020Co-Authors: Howard Y. Park, Vishal Hegde, Stephen D. Zoller, Christopher D. Hamad, William Sheppard, Ryan Smith, Marina Sprague, Joshua D Proal, John Hoang, Amanda H. LoftinAbstract:Abstract BACKGROUND Intrawound vancomycin powder (VP) has been rapidly adopted in Spine surgery with apparent benefit demonstrated in limited, retrospective studies. Randomized trials, basic science, and dose response studies are scarce. PURPOSE This study aims to test the efficacy and dose effect of VP over an extended time course within a randomized, controlled in vivo animal experiment. STUDY DESIGN/SETTING Randomized controlled experiment utilizing a mouse model of Spine Implant infection with treatment groups receiving vancomycin powder following bacterial inoculation. METHODS Utilizing a mouse model of Spine Implant infection with bioluminescent Staphylococcus aureus, 24 mice were randomized into 3 groups: 10 infected mice with VP treatment (+VP), 10 infected mice without VP treatment (No-VP), and 4 sterile controls (SC). Four milligrams of VP (mouse equivalent of 1 g in a human) were administered before wound closure. Bioluminescence imaging was performed over 5 weeks to quantify bacterial burden. Electron microscopy (EM), bacterial colonization assays (Live/Dead) staining, and colony forming units (CFU) analyses were completed. A second dosing experiment was completed with 34 mice randomized into 4 groups: control, 2 mg, 4 mg, and 8 mg groups. RESULTS The (+VP) treatment group exhibited significantly lower bacterial loads compared to the control (No-VP) group, (p CONCLUSIONS Vancomycin powder provided an overall infection prevention benefit but failed to eradicate infection in all mice. Furthermore, the dose when halved also demonstrated an overall protective benefit, albeit at a lower rate. CLINICAL SIGNIFICANCE Vancomycin powder is efficacious but should not be viewed as a panacea for perioperative infection prevention. Dose alterations can be considered, especially in patients with kidney disease or at high risk for seroma.
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290 blood transfusions does storage duration affect postoperative infection risk
The Spine Journal, 2019Co-Authors: Peter P. Hsiue, Sam I Uweh, Clark J Chen, Howard Y. Park, Kellyn R. Hori, Chad R. Ishmael, Zachary D C Burke, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT In the US, approximately 5-10% of Spine surgery patients require postoperative blood transfusions. It is unclear whether or not blood transfusions increase risk of postoperative infections in these patients. Interestingly, while current regulations allow for blood to be stored up to 42 days, recent studies have suggested that prolonged storage may influence postoperative infection risk. PURPOSE The purpose of this study was to compare effects of “old” and “fresh” blood transfusions on infection burden in a mouse model of Spine Implant infection. METHODS C57BL/6 mice were bled aseptically by cardiac puncture for blood collection. Blood was stored for 12 days (old blood) or 1 day (fresh blood) prior to transfusion (both samples were within acceptable transfusion criteria). To model a Spine Implant infection in C57BL/6 mice, a stainless-steel wire was surgically placed in the L4 spinous process and inoculated with a bioluminescent strain of Staphylococcus aureus. Mice were transfused immediately postoperatively and on postoperative day (POD) 1 with 200 microliters of either old blood, fresh blood, or no blood (saline). In vivo bioluminescent imaging (BLI) was used to quantify bacterial burden postoperatively. RESULTS All infected mice demonstrated increased BLI compared to sterile controls. On POD3, mice transfused with old and fresh blood had higher average BLI compared to mice who received no blood. On POD7 and POD10, mice transfused with old blood demonstrated higher average BLI than both fresh and no blood groups. CONCLUSIONS Transfusion of old blood in our mouse model of Spine Implant infection resulted in persistently elevated BLI compared to fresh blood and no blood groups. These findings suggest that storage duration of blood products may indeed increase infection burden and emphasize the need for further research in this area. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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multimodal imaging guides surgical management in a preclinical spinal Implant infection model
JCI insight, 2019Co-Authors: Stephen D. Zoller, Howard Y. Park, Christopher D. Hamad, Kellyn R. Hori, Charles Zamilpa, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Tove Olafsen, Jenchieh TsengAbstract:: Spine Implant infections portend disastrous outcomes, as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. Current imaging modalities can detect anatomical alterations and anomalies but cannot differentiate between infection and aseptic loosening, diagnose specific pathogens, or delineate the extent of an infection. Herein, a fully human monoclonal antibody 1D9, recognizing the immunodominant staphylococcal antigen A on the surface of Staphylococcus aureus, was assessed as a nuclear and fluorescent imaging probe in a preclinical model of S. aureus spinal Implant infection, utilizing bioluminescently labeled bacteria to confirm the specificity and sensitivity of this targeting. Postoperative mice were administered 1D9 probe dual labeled with 89-zirconium (89Zr) and a bars represent SEM dye (NIR680) (89Zr-NIR680-1D9), and PET-CT and in vivo fluorescence and bioluminescence imaging were performed. The 89Zr-NIR680-1D9 probe accurately diagnosed both acute and subacute Implant infection and permitted fluorescent image-guided surgery for selective debridement of infected tissue. Therefore, a single probe could noninvasively diagnose an infection and facilitate image-guided surgery to improve the clinical management of Implant infections.
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friday september 28 2018 10 30 am 12 00 pm abstracts innovation surface technology and biomechanics 177 non invasive pet imaging with zirconium probes accurately localizes staphylococcus aureus Spine Implant infections
The Spine Journal, 2018Co-Authors: Howard Y. Park, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Rachel M Borthwell, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Diagnosis and precise localization of Spine infections are an elusive pursuit. Despite widespread technical advances, the current standard of magnetic resonance imaging lacks the precision to discern infection versus inflammation due to other causes. Nuclear medicine utilizing the metabolic positron emission tomography (PET) probe18F-fluorodeoxyglucose (18F-FDG) can identify inflammation, but it lacks specificity for bacterial infection. However, adjuncts compatible with PET/CT imaging have the potential to noninvasively increase the specificity for bacteria responsible for Spine infections and guide surgeons with regard to the locale and extent of infection. PURPOSE The purpose of this study is to assess the diagnostic potential of utilizing PET/CT and 89-Zirconium (89Zr) labeled bacterial probes in noninvasive, accurate localization of Spine Implant infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden, and PET/CT signal intensity is quantified utilizing 18F-FDG and 89Zr-DFO-1D9 mAb intravenous injections. PATIENT SAMPLE Fifteen12-week-oldC57BL/6 wild type mice were utilized. OUTCOME MEASURES In vivobioluminescence and PET/CT signal intensity was quantified utilizing imaging software. Three-dimensional PET/CT images were utilized to localize signal intensities of interest. METHODS In accordance with an established mouse model of Spine Implant infection, a spinal Implant was fixed into the spinous process of the L4 vertebra. Inoculation of the Implant and wound bed was performed with bioluminescent S. Aureus. On postoperative day 7, 18F-FDG PET/CT imaging was completed in 11 infected and four sterile control mice. They were also injected intravenously via lateral tail vein with 68.6±1.6 μCi (∼14μgmAb) of89Zr-DFO-1D9 mAb. One week following89Zr-DFO-1D9 injection, mice underwent PET/CT to detect 89Zr-DFO-1D9 mAb signal intensities. RESULTS Bioluminescence imaging revealed signal emitted solely from the surgical bed of infected mice which matched that of historical infected controls – bioluminescence signals remained elevated over the duration of the experiment suggestive of sustained bacterial infection. PET-CT imaging with 18F-FDG probe revealed high signal intensity at the site of the Spine Implant with lower levels of signal within the gut, bladder, and heart. The 89Zr-DFO-1D9 mAb probe signal in the region of the Implant was significantly higher in infected mice compared to sterile controls (2.72e9±1.19e9 versus 6.60E8±3.56E8 total radiant efficiency, respectively;p CONCLUSIONS TheS. aureusspecific89Zr-DFO-1D9 mAb probe was shown by PET/CT imaging to accurately detectinfections in-vivo. This study represents the first in-vivo investigation utilizing PET/CT with intravenous bacterial specific probes which may vastly improve the ability to accurately and noninvasively diagnose and localize Spine infections.
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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics: 177. Non invasive, PET imaging with zirconium probes accurately localizes staphylococcus aureus Spine Implant infections
The Spine Journal, 2018Co-Authors: Howard Y. Park, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Rachel M Borthwell, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Diagnosis and precise localization of Spine infections are an elusive pursuit. Despite widespread technical advances, the current standard of magnetic resonance imaging lacks the precision to discern infection versus inflammation due to other causes. Nuclear medicine utilizing the metabolic positron emission tomography (PET) probe18F-fluorodeoxyglucose (18F-FDG) can identify inflammation, but it lacks specificity for bacterial infection. However, adjuncts compatible with PET/CT imaging have the potential to noninvasively increase the specificity for bacteria responsible for Spine infections and guide surgeons with regard to the locale and extent of infection. PURPOSE The purpose of this study is to assess the diagnostic potential of utilizing PET/CT and 89-Zirconium (89Zr) labeled bacterial probes in noninvasive, accurate localization of Spine Implant infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden, and PET/CT signal intensity is quantified utilizing 18F-FDG and 89Zr-DFO-1D9 mAb intravenous injections. PATIENT SAMPLE Fifteen12-week-oldC57BL/6 wild type mice were utilized. OUTCOME MEASURES In vivobioluminescence and PET/CT signal intensity was quantified utilizing imaging software. Three-dimensional PET/CT images were utilized to localize signal intensities of interest. METHODS In accordance with an established mouse model of Spine Implant infection, a spinal Implant was fixed into the spinous process of the L4 vertebra. Inoculation of the Implant and wound bed was performed with bioluminescent S. Aureus. On postoperative day 7, 18F-FDG PET/CT imaging was completed in 11 infected and four sterile control mice. They were also injected intravenously via lateral tail vein with 68.6±1.6 μCi (∼14μgmAb) of89Zr-DFO-1D9 mAb. One week following89Zr-DFO-1D9 injection, mice underwent PET/CT to detect 89Zr-DFO-1D9 mAb signal intensities. RESULTS Bioluminescence imaging revealed signal emitted solely from the surgical bed of infected mice which matched that of historical infected controls – bioluminescence signals remained elevated over the duration of the experiment suggestive of sustained bacterial infection. PET-CT imaging with 18F-FDG probe revealed high signal intensity at the site of the Spine Implant with lower levels of signal within the gut, bladder, and heart. The 89Zr-DFO-1D9 mAb probe signal in the region of the Implant was significantly higher in infected mice compared to sterile controls (2.72e9±1.19e9 versus 6.60E8±3.56E8 total radiant efficiency, respectively;p CONCLUSIONS TheS. aureusspecific89Zr-DFO-1D9 mAb probe was shown by PET/CT imaging to accurately detectinfections in-vivo. This study represents the first in-vivo investigation utilizing PET/CT with intravenous bacterial specific probes which may vastly improve the ability to accurately and noninvasively diagnose and localize Spine infections.
Stephen D. Zoller - One of the best experts on this subject based on the ideXlab platform.
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In vivo Mouse Model of Spinal Implant Infection
Journal of Visualized Experiments, 2020Co-Authors: Benjamin V. Kelley, Stephen D. Zoller, Danielle Greig, Kellyn R. Hori, Nicolas Cevallos, Chad R. Ishmael, Peter P. Hsiue, Rishi Trikha, Troy Sekimura, Thomas OlsonAbstract:Spine Implant infections portend poor outcomes as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. The purpose of this method is to describe a novel mouse model of spinal Implant infection (SII) that was created to provide an inexpensive, rapid, and accurate in vivo tool to test potential therapeutics and treatment strategies for spinal Implant infections. In this method, we present a model of posterior-approach spinal surgery in which a stainless-steel k-wire is transfixed into the L4 spinous process of 12-week old C57BL/6J wild-type mice and inoculated with 1 x 103 CFU of a bioluminescent strain of Staphylococcus aureus Xen36 bacteria. Mice are then longitudinally imaged for bioluminescence in vivo on post-operative days 0, 1, 3, 5, 7, 10, 14, 18, 21, 25, 28, and 35. Bioluminescence imaging (BLI) signals from a standardized field of view are quantified to measure in vivo bacterial burden. To quantify bacteria adhering to Implants and peri-Implant tissue, mice are euthanized and the Implant and surrounding soft tissue are harvested. Bacteria are detached from the Implant by sonication, cultured overnight and then colony forming units (CFUs) are counted. The results acquired from this method include longitudinal bacterial counts as measured by in vivo S. aureus bioluminescence (mean maximum flux) and CFU counts following euthanasia. While prior animal models of instrumented Spine infection have involved invasive, ex vivo tissue analysis, the mouse model of SII presented in this paper leverages noninvasive, real time in vivo optical imaging of bioluminescent bacteria to replace static tissue study. Applications of the model are broad and may include utilizing alternative bioluminescent bacterial strains, incorporating other types of genetically engineered mice to contemporaneously study host immune response, and evaluating current or investigating new diagnostic and therapeutic modalities such as antibiotics or Implant coatings.
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progress not panacea vancomycin powder efficacy and dose evaluated in an in vivo mouse model of Spine Implant infection
The Spine Journal, 2020Co-Authors: Howard Y. Park, Vishal Hegde, Stephen D. Zoller, Christopher D. Hamad, William Sheppard, Ryan Smith, Marina Sprague, Joshua D Proal, John Hoang, Amanda H. LoftinAbstract:Abstract BACKGROUND Intrawound vancomycin powder (VP) has been rapidly adopted in Spine surgery with apparent benefit demonstrated in limited, retrospective studies. Randomized trials, basic science, and dose response studies are scarce. PURPOSE This study aims to test the efficacy and dose effect of VP over an extended time course within a randomized, controlled in vivo animal experiment. STUDY DESIGN/SETTING Randomized controlled experiment utilizing a mouse model of Spine Implant infection with treatment groups receiving vancomycin powder following bacterial inoculation. METHODS Utilizing a mouse model of Spine Implant infection with bioluminescent Staphylococcus aureus, 24 mice were randomized into 3 groups: 10 infected mice with VP treatment (+VP), 10 infected mice without VP treatment (No-VP), and 4 sterile controls (SC). Four milligrams of VP (mouse equivalent of 1 g in a human) were administered before wound closure. Bioluminescence imaging was performed over 5 weeks to quantify bacterial burden. Electron microscopy (EM), bacterial colonization assays (Live/Dead) staining, and colony forming units (CFU) analyses were completed. A second dosing experiment was completed with 34 mice randomized into 4 groups: control, 2 mg, 4 mg, and 8 mg groups. RESULTS The (+VP) treatment group exhibited significantly lower bacterial loads compared to the control (No-VP) group, (p CONCLUSIONS Vancomycin powder provided an overall infection prevention benefit but failed to eradicate infection in all mice. Furthermore, the dose when halved also demonstrated an overall protective benefit, albeit at a lower rate. CLINICAL SIGNIFICANCE Vancomycin powder is efficacious but should not be viewed as a panacea for perioperative infection prevention. Dose alterations can be considered, especially in patients with kidney disease or at high risk for seroma.
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multimodal imaging guides surgical management in a preclinical spinal Implant infection model
JCI insight, 2019Co-Authors: Stephen D. Zoller, Howard Y. Park, Christopher D. Hamad, Kellyn R. Hori, Charles Zamilpa, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Tove Olafsen, Jenchieh TsengAbstract:: Spine Implant infections portend disastrous outcomes, as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. Current imaging modalities can detect anatomical alterations and anomalies but cannot differentiate between infection and aseptic loosening, diagnose specific pathogens, or delineate the extent of an infection. Herein, a fully human monoclonal antibody 1D9, recognizing the immunodominant staphylococcal antigen A on the surface of Staphylococcus aureus, was assessed as a nuclear and fluorescent imaging probe in a preclinical model of S. aureus spinal Implant infection, utilizing bioluminescently labeled bacteria to confirm the specificity and sensitivity of this targeting. Postoperative mice were administered 1D9 probe dual labeled with 89-zirconium (89Zr) and a bars represent SEM dye (NIR680) (89Zr-NIR680-1D9), and PET-CT and in vivo fluorescence and bioluminescence imaging were performed. The 89Zr-NIR680-1D9 probe accurately diagnosed both acute and subacute Implant infection and permitted fluorescent image-guided surgery for selective debridement of infected tissue. Therefore, a single probe could noninvasively diagnose an infection and facilitate image-guided surgery to improve the clinical management of Implant infections.
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friday september 28 2018 10 30 am 12 00 pm abstracts innovation surface technology and biomechanics 177 non invasive pet imaging with zirconium probes accurately localizes staphylococcus aureus Spine Implant infections
The Spine Journal, 2018Co-Authors: Howard Y. Park, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Rachel M Borthwell, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Diagnosis and precise localization of Spine infections are an elusive pursuit. Despite widespread technical advances, the current standard of magnetic resonance imaging lacks the precision to discern infection versus inflammation due to other causes. Nuclear medicine utilizing the metabolic positron emission tomography (PET) probe18F-fluorodeoxyglucose (18F-FDG) can identify inflammation, but it lacks specificity for bacterial infection. However, adjuncts compatible with PET/CT imaging have the potential to noninvasively increase the specificity for bacteria responsible for Spine infections and guide surgeons with regard to the locale and extent of infection. PURPOSE The purpose of this study is to assess the diagnostic potential of utilizing PET/CT and 89-Zirconium (89Zr) labeled bacterial probes in noninvasive, accurate localization of Spine Implant infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden, and PET/CT signal intensity is quantified utilizing 18F-FDG and 89Zr-DFO-1D9 mAb intravenous injections. PATIENT SAMPLE Fifteen12-week-oldC57BL/6 wild type mice were utilized. OUTCOME MEASURES In vivobioluminescence and PET/CT signal intensity was quantified utilizing imaging software. Three-dimensional PET/CT images were utilized to localize signal intensities of interest. METHODS In accordance with an established mouse model of Spine Implant infection, a spinal Implant was fixed into the spinous process of the L4 vertebra. Inoculation of the Implant and wound bed was performed with bioluminescent S. Aureus. On postoperative day 7, 18F-FDG PET/CT imaging was completed in 11 infected and four sterile control mice. They were also injected intravenously via lateral tail vein with 68.6±1.6 μCi (∼14μgmAb) of89Zr-DFO-1D9 mAb. One week following89Zr-DFO-1D9 injection, mice underwent PET/CT to detect 89Zr-DFO-1D9 mAb signal intensities. RESULTS Bioluminescence imaging revealed signal emitted solely from the surgical bed of infected mice which matched that of historical infected controls – bioluminescence signals remained elevated over the duration of the experiment suggestive of sustained bacterial infection. PET-CT imaging with 18F-FDG probe revealed high signal intensity at the site of the Spine Implant with lower levels of signal within the gut, bladder, and heart. The 89Zr-DFO-1D9 mAb probe signal in the region of the Implant was significantly higher in infected mice compared to sterile controls (2.72e9±1.19e9 versus 6.60E8±3.56E8 total radiant efficiency, respectively;p CONCLUSIONS TheS. aureusspecific89Zr-DFO-1D9 mAb probe was shown by PET/CT imaging to accurately detectinfections in-vivo. This study represents the first in-vivo investigation utilizing PET/CT with intravenous bacterial specific probes which may vastly improve the ability to accurately and noninvasively diagnose and localize Spine infections.
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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics: 177. Non invasive, PET imaging with zirconium probes accurately localizes staphylococcus aureus Spine Implant infections
The Spine Journal, 2018Co-Authors: Howard Y. Park, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Rachel M Borthwell, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Diagnosis and precise localization of Spine infections are an elusive pursuit. Despite widespread technical advances, the current standard of magnetic resonance imaging lacks the precision to discern infection versus inflammation due to other causes. Nuclear medicine utilizing the metabolic positron emission tomography (PET) probe18F-fluorodeoxyglucose (18F-FDG) can identify inflammation, but it lacks specificity for bacterial infection. However, adjuncts compatible with PET/CT imaging have the potential to noninvasively increase the specificity for bacteria responsible for Spine infections and guide surgeons with regard to the locale and extent of infection. PURPOSE The purpose of this study is to assess the diagnostic potential of utilizing PET/CT and 89-Zirconium (89Zr) labeled bacterial probes in noninvasive, accurate localization of Spine Implant infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden, and PET/CT signal intensity is quantified utilizing 18F-FDG and 89Zr-DFO-1D9 mAb intravenous injections. PATIENT SAMPLE Fifteen12-week-oldC57BL/6 wild type mice were utilized. OUTCOME MEASURES In vivobioluminescence and PET/CT signal intensity was quantified utilizing imaging software. Three-dimensional PET/CT images were utilized to localize signal intensities of interest. METHODS In accordance with an established mouse model of Spine Implant infection, a spinal Implant was fixed into the spinous process of the L4 vertebra. Inoculation of the Implant and wound bed was performed with bioluminescent S. Aureus. On postoperative day 7, 18F-FDG PET/CT imaging was completed in 11 infected and four sterile control mice. They were also injected intravenously via lateral tail vein with 68.6±1.6 μCi (∼14μgmAb) of89Zr-DFO-1D9 mAb. One week following89Zr-DFO-1D9 injection, mice underwent PET/CT to detect 89Zr-DFO-1D9 mAb signal intensities. RESULTS Bioluminescence imaging revealed signal emitted solely from the surgical bed of infected mice which matched that of historical infected controls – bioluminescence signals remained elevated over the duration of the experiment suggestive of sustained bacterial infection. PET-CT imaging with 18F-FDG probe revealed high signal intensity at the site of the Spine Implant with lower levels of signal within the gut, bladder, and heart. The 89Zr-DFO-1D9 mAb probe signal in the region of the Implant was significantly higher in infected mice compared to sterile controls (2.72e9±1.19e9 versus 6.60E8±3.56E8 total radiant efficiency, respectively;p CONCLUSIONS TheS. aureusspecific89Zr-DFO-1D9 mAb probe was shown by PET/CT imaging to accurately detectinfections in-vivo. This study represents the first in-vivo investigation utilizing PET/CT with intravenous bacterial specific probes which may vastly improve the ability to accurately and noninvasively diagnose and localize Spine infections.
Vishal Hegde - One of the best experts on this subject based on the ideXlab platform.
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progress not panacea vancomycin powder efficacy and dose evaluated in an in vivo mouse model of Spine Implant infection
The Spine Journal, 2020Co-Authors: Howard Y. Park, Vishal Hegde, Stephen D. Zoller, Christopher D. Hamad, William Sheppard, Ryan Smith, Marina Sprague, Joshua D Proal, John Hoang, Amanda H. LoftinAbstract:Abstract BACKGROUND Intrawound vancomycin powder (VP) has been rapidly adopted in Spine surgery with apparent benefit demonstrated in limited, retrospective studies. Randomized trials, basic science, and dose response studies are scarce. PURPOSE This study aims to test the efficacy and dose effect of VP over an extended time course within a randomized, controlled in vivo animal experiment. STUDY DESIGN/SETTING Randomized controlled experiment utilizing a mouse model of Spine Implant infection with treatment groups receiving vancomycin powder following bacterial inoculation. METHODS Utilizing a mouse model of Spine Implant infection with bioluminescent Staphylococcus aureus, 24 mice were randomized into 3 groups: 10 infected mice with VP treatment (+VP), 10 infected mice without VP treatment (No-VP), and 4 sterile controls (SC). Four milligrams of VP (mouse equivalent of 1 g in a human) were administered before wound closure. Bioluminescence imaging was performed over 5 weeks to quantify bacterial burden. Electron microscopy (EM), bacterial colonization assays (Live/Dead) staining, and colony forming units (CFU) analyses were completed. A second dosing experiment was completed with 34 mice randomized into 4 groups: control, 2 mg, 4 mg, and 8 mg groups. RESULTS The (+VP) treatment group exhibited significantly lower bacterial loads compared to the control (No-VP) group, (p CONCLUSIONS Vancomycin powder provided an overall infection prevention benefit but failed to eradicate infection in all mice. Furthermore, the dose when halved also demonstrated an overall protective benefit, albeit at a lower rate. CLINICAL SIGNIFICANCE Vancomycin powder is efficacious but should not be viewed as a panacea for perioperative infection prevention. Dose alterations can be considered, especially in patients with kidney disease or at high risk for seroma.
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104 zoledronic acid decreases infection burden in mouse model of Spine Implant infection
The Spine Journal, 2019Co-Authors: Chad R. Ishmael, Sam I Uweh, Clark J Chen, Vishal Hegde, Kellyn R. Hori, Peter P. Hsiue, Zachary D C Burke, Justo Caballero, Brian K Zukotynski, Cristina VillalpandoAbstract:BACKGROUND CONTEXT Bisphosphonates are commonly used in the orthopedic patient population to manage osteoporosis and other metabolic bone diseases. There is also increasing support for bisphosphonate use in the perioperative setting, to minimize osteolysis and bone loss. Additionally, bisphosphonates are known to affect the host immune system; however, their effect on Implant infections, which are notoriously difficult to treat, remains largely unknown. PURPOSE The purpose of this study was to assess the effect of zoledronic acid (ZA) on spinal Implant infection in our validated mouse model. METHODS Twenty-six 8-week-old C57BL/6 mice were included in the study. Twelve were treated with 250 ug/kg of ZA,12 with normal saline via retro-orbital injection on the day of surgery, and the remaining 2 were sterile controls. A stainless steel pin was then placed into the L4 spinous processes of all mice and site was inoculated with 1E+3 CFUs of bioluminescent Xen36 Staphylococcus aureus in experimental groups. Infection burden was monitored with in vivo bioluminescence imaging at pre-determined intervals. RESULTS Following an initial similar increase after surgery and inoculation, mice treated with ZA showed a decreased bacterial burden as compared to infected control group (p CONCLUSIONS The indications for ZA use continue to expand, and it is often used in the perioperative setting. In our validated mouse model of Spine Implant infection, ZA decreases bacterial burden as compared to controls. Further investigation is required to determine the effects of dosing, location of infection and to explore possible mechanisms by which ZA exerts this effect. These findings may suggest a further benefit to bisphosphonate use in the perioperative setting. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.
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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics: 178. Excising the guesswork: fluorescence-guided infection debridement surgery within a mouse model of Spine infection
The Spine Journal, 2018Co-Authors: Howard Y. Park, Vishal Hegde, Stephen D. Zoller, Christopher D. Hamad, Gideon W Blumstein, William Sheppard, Ryan Smith, Joshua D Proal, Samuel J Clarkson, Zachary D C BurkeAbstract:BACKGROUND CONTEXT Surgical debridement of Spine infections consists of excising tissue at the surgeon's discretion. Surgeon's rely on visual cues such as abnormal tissue coloration and consistency to determine the extent of debridement. However, complete and accurate debridement is difficult to assess given the lack of objective data with regard to location and extent of residual infection. PURPOSE The purpose of this study is to apply two emerging technologies: (1) novelStaphylococcus aureustargeting fluorescently labeled probes and (2) “OR ready” real-time fluorescent imaging system, in a proof of principle study evaluating the feasibility of image-guided debridement surgery. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of spinal Implant infection. BioluminescentStaphylococcus aureusis used for longitudinal quantification of bacterial burden. Once infections were established, an open-air, “OR ready” fluorescent imaging system was utilized for image guided surgery. PATIENT SAMPLE Thirty-six 12-week-oldC57BL/6 wild type mice were utilized, 10 for each experimental group. OUTCOME MEASURES Utilizing an established mouse model of spinal Implant infection,in vivobioluminescence and fluorescence imaging was performed to quantify emitted signals. A recently developed open-air, fluorescence input image-guided surgery system was utilized to for debridement surgery and to evaluate residual bacterial burden on debrided tissue. METHODS Three groups of mice were subjected to a previously established Spine Implant infection model: (1) five mice with Implants inoculated withS. aureusand one sterile control mouse 60 days prior to image-guided debridement, (2) 10 inoculated and five sterile mice 30 days prior, (3) 10 inoculated and five sterile control mice 7 days prior. A total of 24 hours prior to debridement surgery, aS. aureusImmunodominant Staphylococcal Antigen A (IsaA) antibody fluorescent probe was administered via tail vein injection. Fluorescent imaging was completed to confirm co-localization of the probe to bioluminescent bacteria. Mice were then subjected to a fluorescence image-guided surgery system for debridement. RESULTS Two of five mice from the 60-day group, 8/10 of the 30-day group, and 10/10 of the 7-day group established an infection confirmed by bioluminescence imaging. Subsequent fluorescence imaging following IsaA-antibody probe injection revealed co-localization of fluorescent probe to bioluminescent bacteria with high fidelity. Radical debridement of fluorescent material under the image-guided surgery system was completed which revealed fluorescently labeled tissue with continued light emissionex-vivo.No fluorescence remained in mice status post debridement, indicating successful infection excision. CONCLUSIONS The novel,S. aureusspecific fluorescent probe successfully labelled bacteria in chronic and acute Spine Implant infections.Furthermore, this probe was successfully applied to the image-guided surgery system.This technology has the potential to shift the paradigm in excision surgery with applications in infection and negative margin tumor surgery.
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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics
The Spine Journal, 2018Co-Authors: Howard Y.weixian Parkxi, Vishal Hegde, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Spine Implant infections are devastating conditions that incur significant cost and morbidity. Definitive explantation of the Implants is often a last resort as it can destabilize the Spine. Antibiotic eluting Implant coatings have been developed to improve resistance to biofilm infections, although current coatings require a fabrication process that can take several weeks. As such, utilizing branched poly (ethyelene glycol) and poly (allyl mercaptan) (PEG-PAM) polymers, a rapid, point-of-application coating that can be applied in the OR immediately prior to Implantation was developed. PURPOSE This study aims to elucidate the role of the rapid application, novel PEG-PAM polymer coating loaded with antibiotics in the prevention of spinal Implant biofilm infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing spinal Implants coated with PEG-PAM polymer loaded with antibiotics within a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden. PATIENT SAMPLE Twenty 12-week-oldC57BL/6 wild type mice were utilized, 10 for each experimental group. OUTCOME MEASURES Utilizing an established mouse model of spinal Implant infection,in vivobioluminescence imaging was performed using an IVIS Lumina II (PerkinElmer, Hopkinton, MA)on POD 0, 1, 3, 5, 7, 10, 14, 18, 21, and 25 to quantify bacterial burden over time. METHODS A novel, biodegradable coating using branched poly (ethyelene glycol) and poly (allyl mercaptan) (PEG-PAM) polymers was designed to deliver antibiotics. The in vivo efficacy of PEG-PAM coating delivering Vancomycin was tested using a well-established mouse model of spinal Implant infection in which bioluminescent Xen 36Staphylococcus aureuswere inoculated on Implants surgically inserted into the L4 spinous process. PEG-PAM coating alone and PEG-PAM coating with Vancomycin were tested. The primary outcome was the quantity of bioluminescence produced by bacteria for 24 days following inoculation. RESULTS Bioluminescence levels were elevated with the PEG-PAM coating alone with its curve matching historical infected controls. Initial experiments with one layer of PEG-PAM loaded vancomycin revealed no difference in bioluminescence compared to PEG-PAM coating alone. Subsequent experiments with three layers of PEG-PAM loaded with vancomycin revealed complete suppression of infection at all times points (p CONCLUSIONS Based on these data, triple layered PEG-PAM polymer loaded with Vancomycin provides sustained suppression of bacterial infection. The application process of PEG-PAM polymer was completed within minutes obviating the need for prefabrication and potentially maximizing surgeon flexibility within the OR to add various adjuncts as needed.
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combinatory antibiotic therapy increases rate of bacterial kill but not final outcome in a novel mouse model of staphylococcus aureus spinal Implant infection
PLOS ONE, 2017Co-Authors: Yan Hu, Vishal Hegde, Howard Y. Park, Erik M. Dworsky, Stephen D. Zoller, Daniel Johansen, Amanda H. Loftin, Christopher D. Hamad, George E Nelson, Kevin P FrancisAbstract:Background Management of Spine Implant infections (SII) are challenging. Explantation of infected spinal hardware can destabilize the Spine, but retention can lead to cord compromise and biofilm formation, complicating management. While vancomycin monotherapy is commonly used, in vitro studies have shown reduced efficacy against biofilm compared to combination therapy with rifampin. Using an established in vivo mouse model of SII, we aim to evaluate whether combination therapy has increased efficacy compared to both vancomycin alone and infected controls. Methods An L-shaped, Kirschner-wire was transfixed into the L4 spinous process of 12-week-old C57BL/6 mice, and inoculated with bioluminescent Staphylococcus aureus. Mice were randomized into a vancomycin group, a combination group with vancomycin plus rifampin, or a control group receiving saline. Treatment began on post-operative day (POD) 7 and continued through POD 14. In vivo imaging was performed to monitor bioluminescence for 35 days. Colony-forming units (CFUs) were cultured on POD 35. Results Bioluminescence peaked around POD 7 for all groups. The combination group had a 10-fold decrease in signal by POD 10. The vancomycin and control groups reached similar levels on POD 17 and 21, respectively. On POD 25 the combination group dropped below baseline, but rebounded to the same level as the other groups, demonstrating a biofilm-associated infection by POD 35. Quantification of CFUs on POD 35 confirmed an ongoing infection in all three groups. Conclusions Although both therapies were initially effective, they were not able to eliminate Implant biofilm bacteria, resulting in a rebound infection after antibiotic cessation. This model shows, for the first time, why histologic-based, static assessments of antimicrobials can be misleading, and the importance of longitudinal tracking of infection. Future studies can use this model to test combinations of antibiotic therapies to see if they are more effective in eliminating biofilm prior to human trials.
John N. Devine - One of the best experts on this subject based on the ideXlab platform.
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peek biomaterials in trauma orthopedic and spinal Implants
Biomaterials, 2007Co-Authors: Steven M Kurtz, John N. DevineAbstract:Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal Implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of Spine Implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the Spine community. For mature fields, such as total joint replacements and fracture fixation Implants, radiolucency is an attractive but not necessarily critical material feature.
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PEEK biomaterials in trauma, orthopedic, and spinal Implants
Biomaterials, 2007Co-Authors: Steven M Kurtz, John N. DevineAbstract:Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal Implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of Spine Implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the Spine community. For mature fields, such as total joint replacements and fracture fixation Implants, radiolucency is an attractive but not necessarily critical material feature. © 2007 Elsevier Ltd. All rights reserved.
Nicholas M. Bernthal - One of the best experts on this subject based on the ideXlab platform.
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290 blood transfusions does storage duration affect postoperative infection risk
The Spine Journal, 2019Co-Authors: Peter P. Hsiue, Sam I Uweh, Clark J Chen, Howard Y. Park, Kellyn R. Hori, Chad R. Ishmael, Zachary D C Burke, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT In the US, approximately 5-10% of Spine surgery patients require postoperative blood transfusions. It is unclear whether or not blood transfusions increase risk of postoperative infections in these patients. Interestingly, while current regulations allow for blood to be stored up to 42 days, recent studies have suggested that prolonged storage may influence postoperative infection risk. PURPOSE The purpose of this study was to compare effects of “old” and “fresh” blood transfusions on infection burden in a mouse model of Spine Implant infection. METHODS C57BL/6 mice were bled aseptically by cardiac puncture for blood collection. Blood was stored for 12 days (old blood) or 1 day (fresh blood) prior to transfusion (both samples were within acceptable transfusion criteria). To model a Spine Implant infection in C57BL/6 mice, a stainless-steel wire was surgically placed in the L4 spinous process and inoculated with a bioluminescent strain of Staphylococcus aureus. Mice were transfused immediately postoperatively and on postoperative day (POD) 1 with 200 microliters of either old blood, fresh blood, or no blood (saline). In vivo bioluminescent imaging (BLI) was used to quantify bacterial burden postoperatively. RESULTS All infected mice demonstrated increased BLI compared to sterile controls. On POD3, mice transfused with old and fresh blood had higher average BLI compared to mice who received no blood. On POD7 and POD10, mice transfused with old blood demonstrated higher average BLI than both fresh and no blood groups. CONCLUSIONS Transfusion of old blood in our mouse model of Spine Implant infection resulted in persistently elevated BLI compared to fresh blood and no blood groups. These findings suggest that storage duration of blood products may indeed increase infection burden and emphasize the need for further research in this area. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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friday september 28 2018 10 30 am 12 00 pm abstracts innovation surface technology and biomechanics 177 non invasive pet imaging with zirconium probes accurately localizes staphylococcus aureus Spine Implant infections
The Spine Journal, 2018Co-Authors: Howard Y. Park, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Rachel M Borthwell, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Diagnosis and precise localization of Spine infections are an elusive pursuit. Despite widespread technical advances, the current standard of magnetic resonance imaging lacks the precision to discern infection versus inflammation due to other causes. Nuclear medicine utilizing the metabolic positron emission tomography (PET) probe18F-fluorodeoxyglucose (18F-FDG) can identify inflammation, but it lacks specificity for bacterial infection. However, adjuncts compatible with PET/CT imaging have the potential to noninvasively increase the specificity for bacteria responsible for Spine infections and guide surgeons with regard to the locale and extent of infection. PURPOSE The purpose of this study is to assess the diagnostic potential of utilizing PET/CT and 89-Zirconium (89Zr) labeled bacterial probes in noninvasive, accurate localization of Spine Implant infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden, and PET/CT signal intensity is quantified utilizing 18F-FDG and 89Zr-DFO-1D9 mAb intravenous injections. PATIENT SAMPLE Fifteen12-week-oldC57BL/6 wild type mice were utilized. OUTCOME MEASURES In vivobioluminescence and PET/CT signal intensity was quantified utilizing imaging software. Three-dimensional PET/CT images were utilized to localize signal intensities of interest. METHODS In accordance with an established mouse model of Spine Implant infection, a spinal Implant was fixed into the spinous process of the L4 vertebra. Inoculation of the Implant and wound bed was performed with bioluminescent S. Aureus. On postoperative day 7, 18F-FDG PET/CT imaging was completed in 11 infected and four sterile control mice. They were also injected intravenously via lateral tail vein with 68.6±1.6 μCi (∼14μgmAb) of89Zr-DFO-1D9 mAb. One week following89Zr-DFO-1D9 injection, mice underwent PET/CT to detect 89Zr-DFO-1D9 mAb signal intensities. RESULTS Bioluminescence imaging revealed signal emitted solely from the surgical bed of infected mice which matched that of historical infected controls – bioluminescence signals remained elevated over the duration of the experiment suggestive of sustained bacterial infection. PET-CT imaging with 18F-FDG probe revealed high signal intensity at the site of the Spine Implant with lower levels of signal within the gut, bladder, and heart. The 89Zr-DFO-1D9 mAb probe signal in the region of the Implant was significantly higher in infected mice compared to sterile controls (2.72e9±1.19e9 versus 6.60E8±3.56E8 total radiant efficiency, respectively;p CONCLUSIONS TheS. aureusspecific89Zr-DFO-1D9 mAb probe was shown by PET/CT imaging to accurately detectinfections in-vivo. This study represents the first in-vivo investigation utilizing PET/CT with intravenous bacterial specific probes which may vastly improve the ability to accurately and noninvasively diagnose and localize Spine infections.
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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics: 177. Non invasive, PET imaging with zirconium probes accurately localizes staphylococcus aureus Spine Implant infections
The Spine Journal, 2018Co-Authors: Howard Y. Park, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Rachel M Borthwell, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Diagnosis and precise localization of Spine infections are an elusive pursuit. Despite widespread technical advances, the current standard of magnetic resonance imaging lacks the precision to discern infection versus inflammation due to other causes. Nuclear medicine utilizing the metabolic positron emission tomography (PET) probe18F-fluorodeoxyglucose (18F-FDG) can identify inflammation, but it lacks specificity for bacterial infection. However, adjuncts compatible with PET/CT imaging have the potential to noninvasively increase the specificity for bacteria responsible for Spine infections and guide surgeons with regard to the locale and extent of infection. PURPOSE The purpose of this study is to assess the diagnostic potential of utilizing PET/CT and 89-Zirconium (89Zr) labeled bacterial probes in noninvasive, accurate localization of Spine Implant infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden, and PET/CT signal intensity is quantified utilizing 18F-FDG and 89Zr-DFO-1D9 mAb intravenous injections. PATIENT SAMPLE Fifteen12-week-oldC57BL/6 wild type mice were utilized. OUTCOME MEASURES In vivobioluminescence and PET/CT signal intensity was quantified utilizing imaging software. Three-dimensional PET/CT images were utilized to localize signal intensities of interest. METHODS In accordance with an established mouse model of Spine Implant infection, a spinal Implant was fixed into the spinous process of the L4 vertebra. Inoculation of the Implant and wound bed was performed with bioluminescent S. Aureus. On postoperative day 7, 18F-FDG PET/CT imaging was completed in 11 infected and four sterile control mice. They were also injected intravenously via lateral tail vein with 68.6±1.6 μCi (∼14μgmAb) of89Zr-DFO-1D9 mAb. One week following89Zr-DFO-1D9 injection, mice underwent PET/CT to detect 89Zr-DFO-1D9 mAb signal intensities. RESULTS Bioluminescence imaging revealed signal emitted solely from the surgical bed of infected mice which matched that of historical infected controls – bioluminescence signals remained elevated over the duration of the experiment suggestive of sustained bacterial infection. PET-CT imaging with 18F-FDG probe revealed high signal intensity at the site of the Spine Implant with lower levels of signal within the gut, bladder, and heart. The 89Zr-DFO-1D9 mAb probe signal in the region of the Implant was significantly higher in infected mice compared to sterile controls (2.72e9±1.19e9 versus 6.60E8±3.56E8 total radiant efficiency, respectively;p CONCLUSIONS TheS. aureusspecific89Zr-DFO-1D9 mAb probe was shown by PET/CT imaging to accurately detectinfections in-vivo. This study represents the first in-vivo investigation utilizing PET/CT with intravenous bacterial specific probes which may vastly improve the ability to accurately and noninvasively diagnose and localize Spine infections.
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Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics
The Spine Journal, 2018Co-Authors: Howard Y.weixian Parkxi, Vishal Hegde, Stephen D. Zoller, Christopher D. Hamad, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Joshua D Proal, Samuel J Clarkson, Nicholas M. BernthalAbstract:BACKGROUND CONTEXT Spine Implant infections are devastating conditions that incur significant cost and morbidity. Definitive explantation of the Implants is often a last resort as it can destabilize the Spine. Antibiotic eluting Implant coatings have been developed to improve resistance to biofilm infections, although current coatings require a fabrication process that can take several weeks. As such, utilizing branched poly (ethyelene glycol) and poly (allyl mercaptan) (PEG-PAM) polymers, a rapid, point-of-application coating that can be applied in the OR immediately prior to Implantation was developed. PURPOSE This study aims to elucidate the role of the rapid application, novel PEG-PAM polymer coating loaded with antibiotics in the prevention of spinal Implant biofilm infections. STUDY DESIGN/SETTING This is a basic science investigation utilizing spinal Implants coated with PEG-PAM polymer loaded with antibiotics within a mouse model of Spine infection. The Spine Implants are inoculated with bioluminescentStaphylococcus aureusfor longitudinal quantification of bacterial burden. PATIENT SAMPLE Twenty 12-week-oldC57BL/6 wild type mice were utilized, 10 for each experimental group. OUTCOME MEASURES Utilizing an established mouse model of spinal Implant infection,in vivobioluminescence imaging was performed using an IVIS Lumina II (PerkinElmer, Hopkinton, MA)on POD 0, 1, 3, 5, 7, 10, 14, 18, 21, and 25 to quantify bacterial burden over time. METHODS A novel, biodegradable coating using branched poly (ethyelene glycol) and poly (allyl mercaptan) (PEG-PAM) polymers was designed to deliver antibiotics. The in vivo efficacy of PEG-PAM coating delivering Vancomycin was tested using a well-established mouse model of spinal Implant infection in which bioluminescent Xen 36Staphylococcus aureuswere inoculated on Implants surgically inserted into the L4 spinous process. PEG-PAM coating alone and PEG-PAM coating with Vancomycin were tested. The primary outcome was the quantity of bioluminescence produced by bacteria for 24 days following inoculation. RESULTS Bioluminescence levels were elevated with the PEG-PAM coating alone with its curve matching historical infected controls. Initial experiments with one layer of PEG-PAM loaded vancomycin revealed no difference in bioluminescence compared to PEG-PAM coating alone. Subsequent experiments with three layers of PEG-PAM loaded with vancomycin revealed complete suppression of infection at all times points (p CONCLUSIONS Based on these data, triple layered PEG-PAM polymer loaded with Vancomycin provides sustained suppression of bacterial infection. The application process of PEG-PAM polymer was completed within minutes obviating the need for prefabrication and potentially maximizing surgeon flexibility within the OR to add various adjuncts as needed.