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      The antibacterial effect of sonication and its potential medical application

      1 , * , 2


      EDP Sciences

      Ultrasonic, Debridement, Diabetic, Foot, Ulcer, Tenex

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          Introduction: Recent applications of ultrasonic probes include cataract removal and tennis elbow treatment. Early data support the use of ultrasonic probe debridement in the treatment of recalcitrant diabetic foot ulcers. No data are available concerning the potential antibacterial properties of the clinical grade, lower energy ultrasound probes. We investigated the effect of a clinically available ultrasonic debridement probe with respect to bacterial viability.

          Methods: A commercially available Tenex sonication machine with a Tx1 probe was used for this study. Three bacterial strains, aerobic and anaerobic, were investigated, G-negative ( Porphyromonas gingivalis) and G-positive bacteria ( Staphylococcus aureus and Streptococcus gordonii). These bacteria were cultured and tested with sonication for varying lengths of time (10, 30, 60, and 120 s). The tested bacterial samples were plated, the number of colonies on each plate counted, and the anti-bacterial effect was calculated. Statistical analysis was conducted using a one-way analysis of variance.

          Results: Sonication exhibited a significant time-dependent antibacterial effect. Statistically significant anti-bacterial effect was observed in all three species tested. When comparing the kill rate between the control and 120 s of sonication; S. gordonii had a 34% kill rate, S. aureus had a 60% kill rate, and P. gingivalis had a 64% kill rate. When comparing control to all of the time intervals tested, S. aureus kill rate was statistically significant at all times, S. gordonii was statistically significant at all times above 10 s, and P. gingivalis was only statistically significant at 120 s.

          Conclusion: This study demonstrates that a clinically available ultrasonic probe has an antibacterial effect against a wide spectrum of gram-positive, gram-negative, aerobic and anaerobic bacterial species. This may partially explain the dramatic healing of long-standing recalcitrant diabetic ulcers debrided with this device and may have a place in treating pathologies with bacterial mechanisms.

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          Most cited references 6

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          Antimicrobial activity of n-6, n-7 and n-9 fatty acids and their esters for oral microorganisms.

          This study is to assess the antibacterial activity of omega-6, -7, -9 (n-6, n-7, n-9) fatty acids against various oral microorganisms. The n-6, n-7, n-9 fatty acids, such as gamma-linoleic acid (GLA), linoleic acid (LA), arachidonic acid (ARA), palmitoleic acid (PA), and oleic acid (OA), their fatty acid ethyl esters, GLA-EE, LA-EE, ARA-EE, PA-EE, OA-EE, and their fatty acid methyl esters, GLA-ME, LA-ME, ARA-ME, PA-ME, OA-ME, were investigated for antimicrobial activity against oral pathogens Streptococcus mutans, Candida albicans, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Porphyromonas gingivalis. Various concentrations of the fatty acids, their methyl and ethyl esters were tested against various oral pathogens in 96-well plates and blood-agar plate. The plates were incubated anaerobically or aerobically at 37 degrees C for 48h, and the colony forming units (CFU) were determined. The data demonstrated that select n-6, n-7, n-9 fatty acids and their esters exhibited strong antimicrobial activity against these oral microorganisms, demonstrating some specificity for individual microbial species. The potential use or the combinations of the n-6, n-7, n-9 fatty acids and/or their esters, provided in a local delivery vehicle to infected sites in the oral cavity, could be considered as an additional therapeutic approach to improving oral health. 2010 Elsevier Ltd. All rights reserved.
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            A novel bioactivity of omega-3 polyunsaturated fatty acids and their ester derivatives.

            Fish oil, enriched in omega-3 polyunsaturated fatty acids (n-3 PUFA), is widely used as a dietary or nutritional supplement with numerous benefits, including as an anti-inflammatory particularly linked to atherosclerosis. While n-3 PUFA have been suggested to be able to improve oral health through a reduction in inflammation through elevations in these fatty acids in serum and cellular membranes, information is lacking for the possibility that these fatty acids could directly impact the survival and growth of the oral bacteria that trigger the chronic inflammatory responses. The n-3 fatty acids, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA), and their fatty acid ethyl esters, ALAEE, EPAEE, DHAEE were analysed for antibacterial activity against oral pathogens. This study demonstrated a novel bioactivity of the three major n-3 PUFA, EPA, DHA, and ALA, and their ester derivatives. Our experimental data indicated that n-3 PUFA and their ester derivatives exhibited strong antibacterial activity against various oral pathogens, including Streptococcus mutans, Candida albicans, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Porphyromonas gingivalis. This study suggested that n-3 PUFA could have a positive therapeutic effect for improving oral health via their antibacterial activities, besides their anti-inflammatory effects.
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              Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

              Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                17 June 2019
                : 5
                : ( publisher-idID: sicotj/2019/01 )
                [1 ] Department of Orthopaedics and Sports Medicine, Elbow Shoulder Research Center, University of Kentucky 740 South Limestone Lexington 40536 KY USA
                [2 ] Center for Oral Health Research, College of Dentistry, University of Kentucky Lexington 40503 KY USA
                Author notes
                [* ]Corresponding author: srinathkamineni@
                sicotj190040 10.1051/sicotj/2019017
                © The Authors, published by EDP Sciences, 2019

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 6, Pages: 4
                Research Article

                ultrasonic, tenex, ulcer, foot, diabetic, debridement


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