Longer Operative Time Results in a Higher Rate of Subsequent Periprosthetic Joint Infection in Patients Undergoing Primary Joint Arthroplasty

Background

Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study is to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA.

右归丸经IL-6/STAT3信号通路对膝骨关节炎模型大鼠软骨组织退变的调控机制

目的:观察右归丸对膝骨关节炎(KOA)模型鼠软骨组织信号转导和转录激活因子3(STAT3)和白细胞介素-6(IL-6)表达水平的影响。方法:将大鼠随机分为假手术组、模型组、硫酸氨基葡萄糖组、右归丸高、中、低剂量组,每组10只。采用改良Hulth法制备大鼠KOA模型,假手术组和模型组给予等体积生理盐水灌胃,右归丸高、中、低剂量组分别给予右归丸4.8,2.4,1.2 g·kg^-1灌胃,硫酸氨基葡萄糖组给予硫酸氨基葡萄糖0.17 g·kg^-1灌胃,连续给药8周。干预结束24 h后股动脉采血处死各组大鼠,取鼠膝关节软骨,采用苏木素-伊红(HE)染色法观察各组软骨的病理改变,并进行Mankin评分;免疫组化法检测各组关节软骨组织中STAT3,超氧化物歧化酶3(SOD3)和Wnt抑制因子1(WIF1)的表达;实时荧光定量聚合酶链式反应(Real-time PCR)检测软骨组织中IL-6 mRNA的表达;蛋白免疫印迹法(Western blot)检测各组关节软骨组中WIF1蛋白的表达。结果:与假手术组比较,模型组大鼠软骨组织Makin评分明显升高,软骨组织STAT3在蛋白水平上的表达明显增加和IL-6 mRNA水平上的表达显著增加,WIF1在蛋白水平上的表达显著降低(P<0.01);模型组关节软骨边缘严重破坏,软骨细胞排列紊乱。与模型组比较,右归丸高剂量干预组大鼠软骨组织Makin评分,STAT3的在蛋白水平上的表达明显降低,右归丸各干预组IL-6 mRNA水平上的表达显著降低,WIF1在蛋白水平上的表达显著增加(P<0.05,P<0.01),软骨结构趋于正常,软骨细胞分布仅偶见不均,关节软骨表面欠光滑。结论:右归丸能显著改善KOA大鼠的关节软骨退变,抑制KOA中软骨组织的炎症反应,这可能与其抑制STAT3和IL-6的表达有关。     

Surgical Helmets Used During Total Joint Arthroplasty Harbor Common Pathogens: A Cautionary Note

BackgroundThe use of personal-protection surgical helmet/hood systems is now a part of the standard surgical attire during arthroplasty in North America. There are no protocols for the disinfection of these helmets.MethodsThis is a prospective, single-center, observational study. Helmets worn by 44 members of the surgical team and foreheads of 44 corresponding surgical personnel were swabbed at three distinct time points. In addition, 16 helmets were treated with hypochlorite spray to determine if pathogens could be eliminated. Swabs obtained were processed for culture and next-generation sequencing (NGS).ResultsOf the 132 helmet samples, 97 (73%) yielded bacteria on culture and 94 (71%) had evidence of bacterial–deoxyribonucleic acid (DNA) on NGS. Of the swabs sent for bacterial identification at the three time points, at least one from each helmet was positive for a pathogen(s). Of the 132 forehead samples, 124 (93%) yielded bacteria on culture and 103 (78%) had evidence of bacterial-DNA on NGS. The most commonly identified organism from helmets was Cutibacterium acnes (86/132) on NGS and Staphylococcus epidermidis (47/132) on culture. The most commonly identified organism from the foreheads of surgical personnel was Cutibacterium acnes (100/132) on NGS and Staphylococcus epidermidis (70/132) on culture. Sanitization of helmets was totally effective; no swabs taken the following morning for culture and NGS identified any bacteria.ConclusionThis study demonstrates that surgical helmets worn during orthopedic procedures are contaminated with common pathogens that can potentially cause surgical site infections. The findings of this study should at the minimum compel us to develop protocols for the disinfection of these helmets.