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Diamond-like carbon (DLC) coatings doped with bioactive elements of silver (Ag) and copper (Cu) have been receiving increasing attention in the last decade, particularly in the last 5 years, due to their potential to offer a combination of enhanced antimicrobial and mechanical performance. These multi-functional bioactive DLC coatings offer great potential to impart the next generation of load-bearing medical implants with improved wear resistance and strong potency against microbial infections. This review begins with an overview of the status and issues with current total joint implant materials and the state-of-the art in DLC coatings and their application to medical implants. A detailed discussion of recent advances in wear resistant bioactive DLC coatings is then presented with a focus on doping the DLC matrix with controlled quantities of Ag and Cu elements. It is shown that both Ag and Cu doping can impart strong antimicrobial potency against a range of Gram-positive and Gram-negative bacteria, but this is always accompanied so far by a reduction in mechanical performance of the DLC coating matrix. The article concludes with discussion of potential synthesis methods to accurately control bioactive element doping without jeopardising mechanical properties and gives an outlook to the potential long-term impact of developing a superior multifunctional bioactive DLC coating on implant device performance and patient health and wellbeing. Multi-functional diamond-like carbon (DLC) coatings doped with bioactive elements of silver (Ag) and copper (Cu) offer great potential to impart the next generation of load-bearing medical implants with improved wear resistance and strong potency against microbial infections. This article provides a critical review of the state-of-the-art in Ag and Cu doped DLC coatings, beginning with an overview of the current applications of DLC coatings in implant technology followed by a detailed discussion of Ag/Cu doped DLC coatings with particular focus on the relationship between their mechanical and antimicrobial performance. Finally, it ends with a discussion on the potential long-term impact of developing a truly multifunctional ultra-hard wearing bioactive DLC coating to extend the lifetime of total joint implants. [Display omitted] [ABSTRACT FROM AUTHOR]

Although silver nanoparticles (AgNPs) appear to be promising for certain medical/pharmaceutical applications, they present significant disadvantages when it comes to environmental applications due to the need for recovery of the metal (Ag) which is considered hazardous for the environment. The present study examines the antimicrobial properties and mechanism of action of immobilized (on Al 2 O 3) silver nanoparticles' (1 wt% Ag-iNPs) regarding the treatment of E. coli microbial solutions. Antimicrobial experiments were conducted in semi-batch mode using a three-phase continuous flow stirred tank reactor. Every treated sample was taken from the outlet of the reactor for the time intervals of 0, 5 and 25 min. To ensure that the bactericidal property of Ag-iNPs is not attributed to the dissolution of surface silver (as free Ag+), a suitable Ag+ scavenger was used as already described in our earlier studies. Regarding the molecular analysis performed under this study, the regulation of key enzymes involved in bactericidal activity of E. coli, was examined , after their treatment either with immobilized silver nanoparticles (Ag-iNPs) or AgNO 3. Specifically, 50 mL sample for each case was centrifuged (10 min at 10,000 rpm) and the pellet (≈109 cells) was immediately subjected to total RNA extraction. For real-time RT-qPCR analyses, 1 μg of total RNA was converted into cDNA. It was found that PldA gene, which encodes outer membrane's phospholipase A (OMPLA), was up-regulated after 5 and 25 min of treatment with Ag-iNPs. OMPLA's activation appears to be the initial step of Ag-iNPs bactericidal mechanism that ultimately leads to the creation of holes on the outer membrane (OM), irreversibly disturbing the cells' respiration cycle. In addition, after treatment with Ag-iNPs, Blue copper oxidase CueO (encoded by cueO gene) was found to be over-produced and appears to play a key-role in the oxidative transfer of silver from the surface of Ag-iNPs to the cell. This leads to the Ag-induced displacement of copper from its native protein sites such as CusS/CusR, a fact that causes the release of labile copper and ROS inside the cell. In addition, TEM analysis of bacteria treated with Ag-iNPs revealed severe morphological changes ("holes") on bacterial outer membrane, indicating that there is an intermediate step in the proposed antimicrobial mechanism which takes place on the surface of Ag-iNPs. [Display omitted] • Immobilized AgNPs activity is not exclusively attributed to free Ag+ ions. • Ag-iNPs' interaction with OMPLA and CueO enzymes are decisive mechanistic steps. • OMPLA's activation appears to be the initial step of Ag-iNPs bactericidal mechanism. • Ag-induced displacement of Cu from its native proteins leads to ROS overproduction. • TEM studies revealed the formation of Ag-NPs induced "holes" on bacterial outer membrane. [ABSTRACT FROM AUTHOR]

Invasive candidiasis is a life-threatening infection in patients with haematological malignancies. The objective of our study was to determine the incidence, microbiological characteristics and clinical outcome of candidaemia among hospitalized adult patients with haematological malignancies. This is a population-based, prospective, multicentre study of patients ≥18 years admitted to haematology and/or haematopoietic stem cell transplantation units of nine tertiary care Greek hospitals from January 2009 through to February 2012. Within this cohort, we conducted a nested case-control study to determine the risk factors for candidaemia. Stepwise logistic regression was used to identify independent predictors of 28-day mortality. Candidaemia was detected in 40 of 27 864 patients with haematological malignancies vs. 967 of 1 158 018 non-haematology patients for an incidence of 1.4 cases/1000 admissions vs. 0.83/1000 respectively (p <0.001). Candidaemia was caused predominantly (35/40, 87.5%) by non- Candida albicans species, particularly Candida parapsilosis (20/40, 50%). In vitro resistance to at least one antifungal agent was observed in 27% of Candida isolates. Twenty-one patients (53%) developed breakthrough candidaemia while receiving antifungal agents. Central venous catheters, hypogammaglobulinaemia and a high APACHE II score were independent risk factors for the development of candidaemia. Crude mortality at day 28 was greater in those with candidaemia than in control cases (18/40 (45%) vs. 9/80 (11%); p <0.0001). In conclusion, despite antifungal prophylaxis, candidaemia is a relatively frequent infection associated with high mortality caused by non- C. albicans spp., especially C. parapsilosis. Central venous catheters and hypogammaglobulinaemia are independent risk factors for candidaemia that provide potential targets for improving the outcome. [ABSTRACT FROM AUTHOR]

Abstract: Approximately half of essential thrombocythemia (ET) patients and almost all with polycythemia vera (PV) bear the activating JAK2617V>F point mutation, which arises at the multipotent haemopoietic progenitor cell level. Although ET is mainly characterized by megacaryocyte proliferation, the cases that are positive for the JAK2617V>F mutation also show increased bone marrow cellularity and higher erythrocyte and granulocyte counts. After establishing short- and long-term bone marrow cultures we found that the frequency of committed haemopoietic progenitors in the bone marrow, was not increased in JAK2617V>F positive ET compared to the negative ones, whereas in long-term cultures (LTBMC) JAK2617V>F positive ET display a growth pattern more similar to that observed in LTBMC produced by PV marrow cells. Our data support the notion that JAK2617V>F positive ET and PV represents a continuum spectrum of alterations within the same disease. [Copyright &y& Elsevier]