Percutaneous external fixator pins with bactericidal micron-thin sol–gel films for the prevention of pin tract infection

Risk of infection is considerable in open fractures, especially when fracture fixation devices are used to stabilize the fractured bones. Overall deep infection rates of 16.2% have been reported. The infection rate is even greater, up to 32.2%, with external fixation of femoral fractures. The use of percutaneous implants for certain clinical applications, such as percutaneous implants for external fracture fixation, still represents a challenge today.Currently, bone infections are very difficult to treat. Very potent antibiotics are needed, which creates the risk of irreversible damage to other organs, when the antibiotics are administered systemically. As such, controlled, local release is being pursued, but no such treatments are in clinical use. Herein, the use of bactericidal micron-thin sol–gel films on metallic fracture fixation pins is reported. The data demonstrates that triclosan (2,4,4′-trichloro-2′-hydroxydiphenylether), an antimicrobial agent, can be successfully incorporated into micron-thin sol–gel films deposited on percutaneous pins. The sol–gel films continuously release triclosan in vitro for durations exceeding 8 weeks (longest measured time point). The bactericidal effect of the micron-thin sol–gel films follows from both in vitro and in vivo studies. Inserting percutaneous pins in distal rabbit tibiae, there were no signs of infection around implants coated with a micron-thin sol–gel/triclosan film. Healing had progressed normally, bone tissue growth was normal and there was no epithelial downgrowth. This result was in contrast with the results in rabbits that received control, uncoated percutaneous pins, in which abundant signs of infection and epithelial downgrowth were observed. Thus, well-adherent, micron-thin sol–gel films laden with a bactericidal molecule successfully prevented pin tract infection.     

Proposal for using time estimation training for the treatment of Parkinson’s disease

Studies have shown an association between time perception and the basal ganglia and cortical areas, suggesting a role for these regions in the perception of seconds, minutes, and hours. We present the hypothesis that time estimation training tasks may change the modulatory activity of dopamine in the basal ganglia and the cortical areas related to temporal perception. Through this mechanism, the estimated training time interval can promote a compensatory effect on motor and cognitive performance via a dynamic neural adaptation process. We believe that the training will develop a competition between neural pathways involved in the process of time perception, positively affecting the brain pathways related to Parkinson’s disease, and thereby minimizing the cognitive and motor deficits caused by the disease.     

Seventeen-year results of the Denham knee replacement: confined to history,or a valuable lesson for the future?

The Denham knee replacement is a semi-constrained, uni-centric, fully congruous joint replacement that uses intramedullary techniques to accurately reproduce anatomical alignment. A continuing study was made of the originator's series until 1991, with a subsequent independent clinical and radiological review of the surviving implants in 1996. In clinic at an average of 12 years from implantation, the majority of patients had a Hospital for Special Surgery score of Excellent or Good. The average range of movement was 0–90° and the majority of patients were happy with their surgery, although late patellar pain emerged as a problem. Seven percent of the knee replacements had failed with a survivorship of 93% at 10 years, and 81% at 15 years. We conclude that the Denham knee replacement performs at least as well as its contemporaries and that the principal of the fully congruous bearing surface has proven to be effective.     

Higuchi��s fractal dimension for analysis of the effect of external periodic stressor on electrical oscillations in the brain

This study addresses application of Higuchi's fractal dimension (FD) as a measure to evaluate the effect of external periodic stressor on electrical oscillations in the brain. Modulated microwave radiation was applied as a weak periodic stressor with strongly inhomogeneous distribution inside the brain. Experiments were performed on a group of 14 volunteers. Ten cycles (1?min on, 1?min off) of 450-MHz microwave radiation modulated at 40?Hz were applied. Higuchi's FD was calculated in eight symmetric electroencephalographic (EEG) channels located in frontal, temporal, parietal, and occipital areas. FD values averaged over a group detected a small (1-2%) but statistically significant increase with exposure in all EEG channels. FD increased for 12, decreased for one, and was constant for one subject. FD showed the most remarkable effect in temporal and parietal regions of the left hemisphere where the microwave field was maximal. Changes of FD in these regions of the right hemisphere were much higher than expected in accordance with the field distribution. Correlation of FD between different EEG channels was high and retained its value in exposed conditions. Spreading of disturbance between different brain areas is supposed to be crucial for the effect of exposure on the electrical oscillations in the brain.     

Guidelines for return of research results from pediatric genomic studies: deliberations of the Boston Children’s Hospital Gene Partnership Informed Cohort Oversight Board

PurposeApproaches to return individual results to participants in genomic research variably focus on actionability, duty to share, or participants’ preferences. Our group at Boston Children’s Hospital has prioritized participants’ preferences by implementing the Gene Partnership, a genomic research repository, based on the “Informed Cohort” model that offers return of results in accordance with participant preferences. Recognizing that ethical oversight is essential, the Gene Partnership Informed Cohort Oversight Board was convened in 2009.MethodsOver 3 years, the Informed Cohort Oversight Board developed guidelines for the return of individual genomic research results.ResultsThe Informed Cohort Oversight Board defined its guiding principles as follows: to respect the developing autonomy of pediatric participants and parental decision-making authority by returning results consistent with participants’ preferences and to protect participants from harm. Potential harms and strategies to eliminate harm were identified. Guidelines were developed for participant preferences that consider the child’s development and family dynamics. The Informed Cohort Oversight Board agreed that to prevent harm, including harms related to interfering with a child’s future autonomy, there will be results that should not be returned regardless of participant preferences.ConclusionThe Informed Cohort Oversight Board developed guidelines for the return of results that respect the preferences of parents, children, and adult participants while seeking to protect against harm.Genet Med16 7, 547–552.