Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a "miracle weapon" priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a "one size fits all" philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.     

男男性行为者对HIV非职业暴露后预防的认知及相关因素分析

目的 了解MSM对HIV非职业暴露后预防（nPEP）的认知情况,以及使用nPEP的相关因素。方法 2019年3月15日至4月14日,采用滚雪球抽样方法,分别在北京市、深圳市和昆明市MSM社会组织招募年龄≥18岁男性、最近3个月发生过男男性行为、听说过HIV nPEP等符合条件的研究对象,通过“i卫士”收集人口学、行为学特征、nPEP基本知识及其咨询和使用情况。采用logistic回归模型对是否使用nPEP的相关因素进行分析。结果 共调查1 809人,nPEP基本知识知晓率为39.8%（720/1 809）,33.4%（605/1 809）咨询过nPEP,15.0%（271/1 809）使用过nPEP。多因素logistic回归分析结果显示,研究对象使用nPEP的相关因素包括最近3个月与男性HIV感染者发生过性行为（OR=2.58,95%CI：1.64~4.07）、最近1年HIV检测次数≥2次（OR=2.47,95%CI：1.28~5.11）、nPEP基本知识知晓（OR=0.70,95%CI：0.49~0.99）、咨询过nPEP（OR=70.98,95%CI：40.51~136.83）。结论 MSM对nPEP认知不足,应加强MSM的nPEP相关宣传教育,促进MSM发生HIV暴露后尽快使用nPEP。     

Serum-free purified Vero rabies vaccine is safe and immunogenic in children: Results of a randomized phase II pre-exposure prophylaxis regimen study

BackgroundA serum-free, highly purified Vero rabies vaccine (PVRV-NG) has been developed with no animal or human components and low residual DNA content. A phase II randomized clinical study aimed to demonstrate the non-inferiority of the immune response and assess the safety profile of PVRV-NG versus a licensed human diploid cell culture rabies vaccine (HDCV) in a pre-exposure regimen in healthy children and adolescents in the Philippines.MethodologyChildren aged 2–11 years and adolescents aged 12–17 years were randomized (2:1) to receive three injections of either PVRV-NG or HDCV (on day [D] 0, D7 and D28). Rabies virus-neutralizing antibodies (RVNA) were measured at D0, D42 and 6 months after the first injection (month [M] 6). Safety was assessed during the vaccination period and up to 28 days after the last vaccination. Serious adverse events were followed until 6 months after last vaccination.Principal findings342 healthy participants (171 children and 171 adolescents) were randomized and followed for 6 months after the last dose. All participants in both groups had an RVNA titer ≥ 0.5 IU/ml at D42, demonstrating non-inferiority in seroconversion rate for PVRV-NG versus HDCV. Over 90% of participants had RVNA titer ≥ 0.5 IU/ml at M6. PVRV-NG was well tolerated after each vaccination and up to 6 months following the last dose. There were no major safety concerns during the study, and the type and severity of solicited adverse events was similar for both treatment groups.ConclusionsThis study demonstrated the non-inferior immune profile of PVRV-NG compared with HDCV in a pre-exposure setting within a pediatric population. PVRV-NG was well tolerated with no safety concerns. This study is registered at ClinicalTrials.gov (NCT01930357) and EU Clinical Trials Register (2015–003203-30).     

中医药防治经皮腔内冠状动脉成形术后再狭窄的现状和思路

简述经皮腔内冠状动脉成形术(PTCA)后再狭窄发生的机制及中医药防治再狭窄研究的现状。介绍了心脉通胶囊(人参、何首乌、水蛭、丹参等)用于临床防治再狭窄的效果,表明心电图或蹬车试验复查异常率及主要症状复发率,均显著低于对照组;并报告了心脉通胶囊6项基础实验研究的结果。提出气阴两虚、血瘀痰阻是PTCA后再狭窄发生的基本中医病机,并对中医药防治再狭窄的思路进行了讨论。     

The anaesthetist as determinant factor of quality of surgical antimicrobial prophylaxis. A survey in a university hospital.

In actual surgical antimicrobial prophylaxis, the anaesthetist administers the drugs at induction of anaesthesia. In the first phase of our qualityofuse intervention study on antimicrobial drugs in a large university hospital, information on the practice of antimicrobial prophylaxis was needed. The staff of 44 anaesthetists was interviewed by means of a questionnaire. Response rate was 36/44 (82%). The anaesthetists' method of administering surgical prophylaxis was rather uniform and inexpensive: cephalosporins were almost exclusively administered by bolus method. The main reason was that infusion was more cumbersome (range 7785%). Communication between surgeon and anaesthetist was reported to be poor, and in two out of three operating departments, orders of prophylaxis transmitted at or after induction accounted for more than 80%. Seventyseven percent of the responders asked the surgeon if prophylaxis was necessary if they were in doubt; 20% responded that they checked it systematically. The data collected by the inquiry proved useful in the process of optimizing surgical prophylaxis in our hospital.     

Prospective randomized clinical study in general surgery comparing a new low molecular weight heparin with unfractionated heparin in the prevention of thrombosis

A prospective, randomized, controlled clinical trial was performed comparing the antithrombotic efficacy of the low molecular weight heparin LMWH 21–23, (Braun) with an unfractionated heparin in elective general surgical patients over an observation period of 7 postoperative days. A total of 230 patients were admitted: 103 (group I) received low molecular weight heparin and 100 (group II) low-dose unfractionated heparin treatment given subcutaneously. In group I 41 patients (46%) were operated on for malignant disease and in group II 54 patients (54%). Due to the large amount of great abdominal procedures the intra- and perioperative application of hydroxyethyl starch was allowed for volume substitution. None of the patients died due to fatal pulmonary embolism. In group I four patients revealed positive ¹²⁵I-labeled fibrinogen uptake (3.9%); two patients belonged to the hydroxyethyl starch subgroup. In group II five patients displayed a positive fibrinogen uptake (5%); two belonged to the hydroxyethyl starch subgroup. The results of the hemostaseological investigations (e.g., prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen, antithrombin III, protein C, plasminogen, ₂-antiplasmin , tissue-type plasminogen activator, plasminogen activator inhibitor) revealed no statistically significant differences between groups I and II or their subgroups, although a tendency to prolonged clotting times was observed. The antifactor Xa activity values, however, displayed a statistically significant difference between the two groups (P < 0.05). The antifactor Xa activity measured up to 0.16 U/ml for the low molecular weight heparin (group I) and 0.05 U/ml for the unfractionated heparin (group II) in the postoperative period. Major bleeding complications were not encountered in this study. Fundamental for the low incidence of thrombosis, the additive administration of hydroxyethyl starch appeared in almost one-third of the patients in both study groups.Abbreviations APTT activated partial thromboplastin time - aXa anti-factor Xa - DVT deep venous thrombosis - FUT ¹²⁵I-labeled fibrinogen uptake test - HES hydroxyethyl starch - LMWH low molecular weight heparin - PE pulmonary embolism - UFH unfractioned heparin     

Increased incidence of retching and vomiting during periovulatory phase after middle ear surgery

Purpose  

To assess the effect of the menstrual cycle on post-operative retching and vomiting (R& V) after middle ear surgery, and the efficacy of prophylaxis against R& V in female patients with transdermal scopolamine during either general or local anaesthesia and with intravenous ondansetron during general anaesthesia.     

Peri-operative elastase-α-1 proteinase inhibitor in patients with postoperative intervertebral discitis

Summary In a prospective study of 251 patients operated upon for lumbar disc herniation it has been investigated whether the preoperative and early postoperative values of Elastase--1 Proteinase Inhibitor (EPI) — an indicator of inflammatory processes — and C-reactive Protein (CRP) — a well known predictor of some postoperative complications — were correlated to the later development of discitis. Postoperatively discitis developed in 14 patients. A randomly choosen group of 15 complication-free patients out of the total of 251 cases was used as control group.Elevated EPI plasma values, especially in the pre-operative and first postoperative days, turned out to be significantly related to the likelyhood of later discitis development, but no such relation for the CRP plasma values could be established. Thus and early prediction of patients at risk for this complication seems to be possible by pre- and postoperative measurement of EPI. It could be justified —but its usefulness has yet to be proven — to give antibiotics prophylactically and other anti-inflammatory medication in patients with elevated pre- and postoperative EPI values.     

Effectiveness of low-dose contrimoxazole prophylaxis against Pneumocystis carinii pneumonia after renal and/or pancreas transplantation

We retrospectively examined the effectiveness of prophylaxis with cotrimoxazole in preventing Pneumocystis carnii pneumonia in recipients of kidney and combined kidney-pancreas transplants between 1985 and 1989. Cotrimoxazole prophylaxis (480 mg daily or 300 mg/m²), when used, was started within 2 months after transplantation and usually continued until 6 months after surgery. Eight (3.7%) of the 214 patients who were not given prophylaxis were infected with Pneumocystis carinii, and there were 4 fatalities (50% mortality). There were no cases among the 161 patients given prophylaxis (P 0.03). No serious adverse effects were noted in the prophylaxis group. It is concluded that prophylaxis against Pneumocystis carinii infection is well tolerated and should be given as soon as possible to all organ transplant recipients for at least 6 months.