Synovial Fluid Calprotectin for the Preoperative Diagnosis of Chronic Periprosthetic Joint Infection

BackgroundThe diagnosis of periprosthetic joint infection (PJI) represents a challenge in clinical practice and the analysis of synovial fluid is a useful diagnostic tool. Calprotectin is an inflammatory biomarker widely used in the evaluation of chronic inflammatory diseases; however, little is known about its role in PJI. The purpose of this study is to determine the reliability of synovial calprotectin in the diagnosis of PJI.MethodsSeventy-six patients with painful knee arthroplasty were included in this prospective observational study. Synovial fluid was analyzed for cell count, percentage of polymorphonuclear neutrophils, microbiological culture, leukocyte esterase strip test, alpha-defensin rapid test, and calprotectin immunoassay dosage. The 2018 Consensus Statements criteria for PJI were used as standard reference to define the presence of infection. Sensitivity, specificity, positive and negative likelihood ratio, and receiver-operation characteristic curve were calculated for calprotectin immunoassay test.ResultsBy 2018 Consensus Statements criteria for PJI, 28 patients were considered infected, 44 patients were considered not infected, and 4 patients were classified as inconclusive. The calprotectin synovial fluid test resulted in 2 false-positive results and no false-negative results. The calprotectin synovial fluid test demonstrated a sensitivity of 100% (95% confidence interval [CI] 99.96-100) and specificity of 95% (95% CI 89.4-100) for the diagnosis of PJI. The positive likelihood ratio was 22 (95% CI 5.680-85.209) and the negative likelihood ratio was 0 (95% CI 0-0.292). The area under the receiver-operation characteristic curve was 0.996 (95% CI 94.3-100).ConclusionThe present study suggests that synovial calprotectin immunoassay test has a high sensitivity and specificity in the diagnosis of knee PJI. Moreover, it is easily applied, quick and valuable in clinical practice.     

Diagnostic Value of Clinical Grind Test for Carpometacarpal Osteoarthritis of the Thumb

Study DesignClinical Measurement.IntroductionThumb carpometacarpal (CMC) osteoarthritis is a frequent cause of thumb pain.Purpose of the StudyTo evaluate the interrater reliability and the criterion validity of the grind test for thumb CMC osteoarthritis.MethodsRadiological evaluation was used as the gold standard. Seventy thumbs of 54 persons with various hand disorders were included in the study. The grind test was performed by two physical therapists, and radiographs were evaluated by a certified hand surgeon, all blinded to the participants' diagnosis and other test results. Interrater reliability was compared with a kappa statistic, and the sensitivity, specificity, likelihood ratios, and predictive values were calculated from a 232 table.ResultsA kappa value of 0.48 was calculated as the interrater reliability. The sensitivity of the grind test was 42% and 53%, depending on tester. The specificity of the grind test was 80% and 93%, depending on tester. The positive likelihood ratio was 2.65 and 6.00, and the negative likelihood ratio was 0.59 and 0.62. The positive predictive value was 91% and 96%, depending on tester. The negative predictive value was 68% and 70%, depending on tester.ConclusionThe grind test has moderate reliability and accurately confirms the diagnosis of CMC osteoarthritis and identifies those who do not have CMC osteoarthritis. However, a negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis.Level of Evidencen/a     

Can the Leukocyte Esterase Strip Test Predict Persistence of Periprosthetic Joint Infection at Second-Stage Reimplantation?

BackgroundWe evaluated the reliability of intraoperative assessment of leukocyte esterase (LE) in synovial fluid samples from patients undergoing reimplantation following implant removal and spacer insertion for periprosthetic joint infection (PJI). Our hypothesis was that a positive intraoperative LE test would be a better predictor of persistent infection than either serum C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) or the combination of serum CRP and ESR.MethodsThe records of 76 patients who received a 2-stage exchange for PJI were retrospectively reviewed. Synovial fluid was collected for LE measurement during surgery before arthrotomy in 79 procedures. Receiver operating characteristic curves were generated. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve (AUC) of LE, CRP, ESR, and CRP + ESR were calculated.ResultsSensitivity, specificity, positive predictive value, and negative predictive value of the LE assay were 82%, 99%, 90%, and 97%, respectively. Receiver operating characteristic analysis revealed an LE threshold of 1.5 between the first (negative) and the second (positive) level of the ordinal variable, so that a grade starting from 1+ was accurate for a diagnosis of persistent infection (AUC 0.9044). The best thresholds for the CRP and the ESR assay were 8.25 mg/L (82% sensitivity, 84% specificity, AUC 0.8416) and 45 mm/h (55% sensitivity, 87% specificity, AUC 0.7493), respectively.ConclusionThe LE strip test proved a reliable tool to diagnose persistence of infection and outperformed the serum CRP and ESR assays. The strip test provides a valuable intraoperative diagnostic during second-stage revision for PJI.     

Leukocyte Esterase Versus ICM 2018 Criteria in the Diagnosis of Periprosthetic Joint Infection

BackgroundA leukocyte esterase (LE) test is inexpensive and provides real-time information about patients suspected of periprosthetic joint infections (PJIs). The 2018 International Consensus Meeting (ICM) recommends it as a diagnostic tool with a 2+ cutoff. There is still a lack of data revealing LE utility versus the ICM 2018 criteria for PJI.MethodsThis is a retrospective study of patients who underwent revision total hip and total knee arthroplasty at a single institution between March 2009 and December 2019. All patients underwent joint aspiration before the arthrotomy, and the LE strip test was performed on aspirated joint fluid. PJI was defined using the 2018 ICM criteria.ResultsAs per the 2018 ICM criteria, 78 patients were diagnosed with chronic PJI and 181 were not infected. An LE test with a cutoff of $\ge$1+ had a sensitivity of 0.744, a specificity of 0.906, a positive predictive value of 0.773, an accuracy of 0.825 (95% confidence interval 0.772-0.878), and a negative predictive value of 0.891. The positive likelihood ratio (LR+) was 7.917. Using an LE cutoff of 2 + had a sensitivity of 0.513, a specificity of 1.000, and an accuracy of 0.756 (95% confidence interval—0.812).ConclusionLE is a rapid and inexpensive test which can be performed at the bedside. Its performance is valuable as per ICM criteria. Based on the findings of this study and the given cohort, we suggest using the cutoff of LE1+ (result = negative or trace) as a point of care test to exclude infection, whereas LE at 2 + threshold has near absolute specificity for the diagnosis.     

Synovial Biomarkers to Detect Chronic Periprosthetic Joint Infection: A Pilot Study to Compare Calprotectin Rapid Test,Calprotectin ELISA Immunoassay and Leukocyte Esterase Test

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication after joint replacement surgery, and making diagnosis is often far from obvious. Calprotectin was recently proposed as a promising synovial biomarker to detect PJI. To our knowledge, no comparative study exists between enzyme-linked immunosorbent assay (ELISA) and rapid calprotectin test (CalFAST). Our purpose was to compare these methods with leukocyte esterase (LE) test from synovial fluid of painful knee arthroplasty subjected to infectious workup.MethodsNinety-three patients were included in this prospective observational study. They underwent synovial fluid aspiration that was analyzed for cell count, microbiological culture, LE test, calprotectin rapid test, and calprotectin immunoassay dosage. The 2018 Consensus Statements criteria for PJI were used to diagnose PJI. Sensitivity, specificity, positive and negative likelihood ratio, and receiver operating characteristic were calculated for detection methods and compared.ResultsWe categorized 39 patients as infected and 50 patients as not infected. The sensitivity comparing the ELISA test and CalFAST test was similar, 92.3% and 97.4%, respectively. LE rapid test showed 46% of sensitivity and 94% of specificity. The highest specificity was found with ELISA test (100%). Comparing the receiver operating characteristic curves by z-test, there were statistically significant differences between LE strip test and the other two methods. Otherwise, no statistically significant differences were present between ELISA and CalFAST test.ConclusionSynovial calprotectin detection has high accuracy in knee PJI diagnosis, both ELISA and rapid test. LE strip test remains a good test to confirm the diagnosis of PJI in case of positivity. In clinical practice, the calprotectin rapid test can be considered an excellent point-of-care test.     

Puncture Protocol in the Diagnostic Work-Up of a Suspected Chronic Prosthetic Joint Infection of the Hip

Background

Diagnosing a chronic prosthetic joint infection (PJI) can be challenging. We hypothesized that obtaining preoperative tissue samples for culture in hip arthroplasty will increase the likelihood of diagnosing an infection before revision surgery. The aim of this cohort study was to determine the diagnostic accuracy of 2 tissue acquiring biopsy strategies to diagnose a PJI.

The Comparison of Ottawa Ankle Rules and Shetty test performances in foot-ankle trauma patients visited to the emergency department

BackgroundThe Ottawa Ankle Rules (OARs) and Shetty test (ST), are assessment guidelines intended to minimize radiographs in patients with ankle trauma. The aim of this study is to determine and compare the effectiveness of OARs and ST in patients admitted to the emergency department (ED) with foot and ankle trauma.MethodsThis prospective cohort study was carried out in the ED of a tertiary care teaching hospital. OARs and ST were practiced by different doctors to patients, who were admitted with foot and ankle trauma. X-ray images were analyzed by a radiologist. Accuracy measures were covered such as sensitivity, specificity, positive predictive value, negative predictive value.ResultsThe study was completed a total of 207 patients, after achieving the inclusion and exclusion criteria. The mean age of the patients was 33.1±16.3, and 96 (46.4%) were female. For OARs, it was determined that as sensitivity 97.22%, specificity 48.89%, positive predictive value 50.36%, negative predictive value 97.06%, positive likelihood ratio 1.9 and negative likelihood ratio 0.06. If the OARs had been used, there would have been a 32.8% reduction in the ankle X-ray system. For the ST, it was determined that as sensitivity 51.39%, specificity 85.93%, positive predictive value 66.07%, negative predictive value 76.82%, positive likelihood ratio 3.65 and negative likelihood ratio 0.57.DiscussionThe OARs can be used as a screening tool, due to causing the high sensitivity in foot and ankle traumas. The ST was found to be inefficient in this study. In addition, the significant reduction in the number of X-rays with the use of OARs is another major result of the study.     

Synovial Cell Count Before Reimplantation Can Predict the Outcome of Patients with Periprosthetic Knee Infections Undergoing Two-stage Exchange

BackgroundAlthough synovial fluid can be used to diagnose periprosthetic joint infections (PJI) effectively, only the cutoff values adopted at the time of PJI diagnosis have been standardized, and few data are currently available about effectiveness of synovial fluid examination before definitive reimplantation.Questions/purposesWe asked: (1) What are the most appropriate thresholds for synovial fluid leukocyte counts (WBC) and neutrophil percentage (PMN percentage) in a patient group undergoing definitive reimplantation after an uninterrupted course of antibiotic therapy for chronic PJI? (2) What is the predictive value of our synovial WBC and PMN percentage threshold compared with previously proposed thresholds?MethodsIn all, 101 patients with PJI were evaluated for inclusion from January 2016 to December 2018. Nineteen percent (19 of 101) of patients were excluded because of the presence of a chronic inflammatory disease, acute/late hematogenous infection, low amount of synovial fluid for laboratory investigations or infection persistence after spacer placement, and adequate antibiotic therapy. Finally, 81% (82 of 101) of patients with a median (range) age of 74 years (48 to 92) undergoing two-stage revision for chronic TKA infection, who were followed up at our institution for a period 96 weeks or more, were included in this study. The patients did not discontinue antibiotic treatment before reimplantation and were treated for 15 days after reimplantation if intraoperative cultures were negative. No patient remained on suppressive treatment after reimplantation. Synovial fluid was aspirated aseptically with a knee spacer in place to evaluate the cell counts before reimplantation. Thirteen percent (11 of 82) of patients had persistent or recurrent infection, defined as continually elevated erythrocyte sedimentation rate or C-reactive protein levels coupled with local signs and symptoms or positive cultures. The synovial fluid WBC counts and PMN percentage from the 11 patients with persistent or recurrent PJI were compared with the 71 patients who were believed to be free of PJI. Receiver operating characteristic (ROC) curve analyses assessed the predictive value of the parameters, and the areas under the curves (AUCs) were evaluated. The sensitivities, specificities, and positive and negative predictive values were determined for the WBC count and PMN percentage. Patients with persistent or recurrent infection had higher median WBC counts (471 cells/µL versus 1344 cells/µL; p < 0.001) and PMN percentage (36% versus 61%; p < 0.001) than did patients believed to be free of PJI.ResultsROC curve analysis identified the best threshold values to be a WBC count of 934 cells/µL or more (sensitivity 0.82 [95% CI 0.71 to 0.89], specificity 0.82 [95% CI 0.71 to 0.89]) as well as a PMN percentage of at least 52% (sensitivity 0.82 [95% CI 0.71 to 0.89] and specificity 0.78 [95% CI 0.67 to 0.86]. We found no difference between the AUCs for the WBC count and the PMN percentage (0.87 [95% CI 0.79 to 0.96] versus 0.84 [95% CI 0.73 to 0.95]. Comparing the sensitivities and specificities of the synovial fluid WBC count and PMN percentage proposed by other authors, we find that a PMN percentage more than 52% showed better predictive value than previously reported.ConclusionBased on our findings, we believe that patients with WBC counts of at least 934 and PMN percentage of 52% or more should not undergo reimplantation but rather a repeat debridement, as their risk of persistent or recurrent PJI appears prohibitively high. The accuracy of the proposed cutoffs is better than previously reported.Level of EvidenceLevel III, diagnostic study.     

The Utility of Serum d-Dimer for the Diagnosis of Periprosthetic Joint Infection in Revision Total Hip and Knee Arthroplasty

BackgroundThere is scarce and contradicting evidence supporting the use of serum d-dimer for the diagnosis of periprosthetic joint infection in revision total hip (THA) and knee (TKA) arthroplasty. Therefore, the purpose of this study is to test the accuracy of serum d-dimer against the 2013 International Consensus Meeting (ICM) criteria.MethodsA retrospective review was performed on a consecutive series of 172 revision THA/TKA surgeries performed by 3 fellowship-trained surgeons at a single institution (August 2017 to May 2019) and that had d-dimer performed during their preoperative workup. Of this cohort, 111 (42 THAs/69 TKAs) cases had complete 2013 ICM criteria tests and were included in the final analysis. Septic and aseptic revisions were categorized per 2013 ICM criteria (“gold standard”) and compared against serum d-dimer using an established threshold (850 ng/mL). Sensitivity, specificity, likelihood ratios, and positive/negative predictive values were determined. Independent t-tests, Fisher’s exact tests, chi-squared tests, and receiver operating characteristic curve analysis were performed.ResultsThere was no statistically significant difference in baseline demographics between septic and aseptic cases per 2013 ICM criteria. When compared to ICM criteria, d-dimer demonstrated high sensitivity (95.9%) and negative predictive value (90.9%) but low specificity (32.3%), positive predictive value (52.8%), and overall, poor accuracy (61%) to diagnose periprosthetic joint infection. Positive likelihood ratio was 1.42 while negative likelihood ratio was 0.13. The area under the curve (AUC) was 0.742.ConclusionSerum d-dimer has poor accuracy to discriminate between septic and aseptic cases using a described threshold in the setting of revision THA and TKA.     

The Alpha-Defensin Prosthetic Joint Infection Test Has Poor Validity for Native Knee Joint Infection

BackgroundThe alpha-defensin test known as Synovaure has been very effective in diagnosis of prosthetic joint infections (PJIs). Being able to easily and accurately differentiate septic and inflammatory arthropathies in native joints would improve diagnostic workup and management. We tested the ability of an alpha-defensin test to distinguish septic from inflammatory or crystalline arthropathy in the native knee.Methods40 native knee joint fluid specimens were tested with cell count, fluid analysis, and culture and alpha-defensin testing. We determined the sensitivity and specificity of the alpha-defensin test using culture-positive fluid as the gold standard for septic arthropathy and positive crystals as the gold standard for crystalline arthropathy.ResultsThe Synovasure PJI test had 100% specificity for septic arthritis coupled with a 28% false-positive rate when applied to native knee aspirations. False-positive rate was 5.3 times higher in patients with crystals found in the joint fluid.ConclusionAlpha-defensin testing, in the form of the Synovasure PJI test, has a high-false-positive rate when used to distinguish septic and inflammatory arthritis in the native knee joint. Future work will need to determine the sensitivity and specificity of the newer native joint panel. Clinicians should be cognizant of the specific alpha-defensin test used when sampling native knee synovial fluid.     

Diagnostic accuracy of physical examination findings for midfacial and mandibular fractures

ObjectivesTo assess the diagnostic accuracy of physical examination findings used to identify patients at risk for midfacial or mandibular fractures.Materials and MethodsA five-year retrospective cohort was constructed from all emergency department patients with a midfacial or mandibular trauma. The sensitivity, specificity, pre-test probability, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio data was calculated for 19 and 14 physical examination findings for midfacial and mandibular fractures respectively. Computed Tomography and panoramic radiography were used as index tests.ResultsA total of 1484 patients were identified among whom 40.4% midfacial and 33.4% mandibular fractures were diagnosed. Overall, specificity was found to be higher than sensitivity. Regarding midfacial fractures, high specificity was found for raccoon eyes, malar eminence flattening and all the findings that are related to palpation, the nasal, ocular and intra-oral assessment. Malar eminence flattening, external nasal deformity, nasal septum hematoma, change of globe position and palpable step-off had ad high positive predictive value and positive likelihood ratio. Regarding mandibular fractures high specificity was found for mouth opening restriction, auditory canal bleeding, intra-oral assessment related findings, palpable step-off, inferior alveolar nerve paresthesia, the angular compression test and chin axial pressure test.ConclusionsThe diagnostic accuracy of relevant physical examination findings were identified for the prediction of midfacial and mandibular fractures.     

Determining False Positive Rates of Leukocyte Esterase Reagent Strip When Used as a Detection Tool for Joint Infection

Background

Use of leukocyte esterase (LE) testing of synovial fluid as an adjunct to the infection workup in total joint arthroplasty patients has been advocated. The purpose of this study was to determine the false positive rate of this test.

Decreased laboratory testing for lecithin-to-sphingomyelin ratio and phosphatidylglycerol after fetal lung maturity assessment from lamellar body count in amniotic fluid

The objectives of this study were to do inexpensive lamellar body count (LBC) in amniotic fluid, to do statistical analysis to evaluate cutoff values for fetal lung maturity (FLM) and fetal lung immaturity (FLI), to derive a threshold for obtaining a lecithin-to-sphingomyelin (L/S) ratio and phosphatidylglycerol percentage (%PG), and to determine the potential cost savings to the hospital if they use this new method. Testing (LBC, L/S ratio, and %PG) was done on 123 specimens of amniotic fluid. Receiver operating characteristic (ROC) curve, discriminant, linear regression, chi2, and cost analyses were used to evaluate the laboratory and financial parameters. Lamellar body counts of greater than 41,500 (Coulter MAXM: sensitivity, 90.5%; specificity, 87.7%; positive predictive value, 79.2%; negative predictive value, 94.7%) and greater than 32,000 (Coulter Gen.S: sensitivity, 90.5%; specificity, 85.2%; positive predictive value, 76.0%; negative predictive value, 94.5%) were the best threshold for biochemical FLM. Similarly, LBC of less than 24,000 (MAXM: sensitivity, 78.6%; specificity, 100%; positive predictive value, 100%; negative predictive value, 90.0%) and less than 21,000 (Gen.S: sensitivity, 71.4%; specificity, 100%; positive predictive value, 100%; negative predictive value, 87.1%) provided the best statistical cutoff for biochemical FLI from discriminant analysis. The authors concluded that FLM and FLI can be predicted with reasonable accuracy from LBC in amniotic fluid specimens. The expensive and not easily accessible L/S ratio and %PG can then be done only in cases in which LBC indicates transitional FLM. A cascade approach results in 86% savings to the hospital if the L/S ratio and %PG are not sent to a reference laboratory.     

The role of FDG-PET-CT is limited in initial staging of nodal metastasis for thin cutaneous melanoma

IntroductionPositron emission tomography computed tomography (PET-CT) is often used to stage nodal metastases in thin cutaneous melanoma, with limited evidence.MethodsA retrospective review of patients with cutaneous malignant melanoma treated at our institution was performed from 2005 to 2015, identifying those who received a PET-CT prior to lymphadenectomy. Biopsy features, lymph node status, and PET-CT results were collected. We calculated the overall sensitivity, specificity, accuracy, likelihood ratios, and positive predictive value of PET-CT in identifying nodal metastases. Results were stratified by initial biopsy tumor depth.ResultsWe identified 367 cases; 95 obtained a PET-CT prior to lymphadenectomy. Overall, sensitivity and specificity of PET-CT was 34.6% and 95.4%, respectively. The positive likelihood ratio and negative likelihood ratio were 7.62 and 0.68, respectively. The accuracy was 78.2%. The positive predictive value for T3 and T4 melanomas were 100% and 81.4%, respectively. For thin melanomas, specificity and accuracy was 88.2% and 88.2%, respectively.ConclusionsPET-CT has low specificity and its use alone is not recommended for initial staging of nodal metastases in thin cutaneous malignant melanoma.     

Diagnostic Accuracy of the Alpha-Defensin Test for Periprosthetic Joint Infection in Patients With Inflammatory Diseases

BackgroundThe alpha-defensin test has been reported to have high accuracy to diagnose periprosthetic joint infection (PJI). There are remaining concerns about the utility of the test in patients with inflammatory diseases. The purpose of this study is to determine sensitivity and specificity of laboratory-based alpha-defensin in diagnosing PJI in patients with systemic inflammatory disease in revision total hip/knee arthroplasty.MethodsA retrospective review was conducted of 1374 cases who underwent revision total hip/knee arthroplasty at a single healthcare system from 2014 to 2017. Cases with inflammatory diseases who received a 1-stage revision arthroplasty, the first stage of 2-stage revision arthroplasty, or irrigation and debridement with available preoperative alpha-defensin results were included. Patients who received a second-stage procedure, spacer exchange, who had insufficient Musculoskeletal Infection Society criteria, or with early postoperative PJI were excluded from this study. Cases were classified as infected or not according to Musculoskeletal Infection Society criteria. A total of 41 cases met the inclusion criteria. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of alpha-defensin to diagnose PJI were calculated.ResultsThe alpha-defensin test demonstrated a sensitivity of 93%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 96%, and an accuracy of 97% for diagnosing PJI. There was 1 patient with polymyositis who had a false-negative result.ConclusionAlpha-defensin had high accuracy for diagnosing PJI even in inflammatory diseases. The alpha-defensin test provides useful information with high accuracy in diagnosing PJI in patients with inflammatory diseases.     

人体重心测试系统诊断颈性眩晕的评价

目的：建立一种生物力学测试方法,为临床诊断颈性眩晕提供量化依据。方法：2004年7月至2006年11月,应用人体重心测试系统对86例正常人（男40例,女46例;年龄20～74岁,平均30岁）和75例颈性眩晕患者（男16例,女59例;年龄20～74岁,平均44.5岁）进行定量测试和定性诊断,并用目前颈性眩晕的临床诊断方法（cur-rent diagnosical method of cervical vertigo,CDM法）作为对照,进行临床诊断性试验。对静态站立睁、闭眼时重心测试诊断颈性眩晕（static posturography method of cervical vertigo,SPG法）的临床价值进行评价。结果：闭眼时SPG法诊断颈性眩晕的灵敏度为76%,特异度为93%,Youden指数为69%,符合率为85.1%;阳性预测值为90.5%,阴性预测值为93%,阳性似然比为10.893,阴性似然比为0.258。睁眼时SPG法诊断颈性眩晕的灵敏度为49.3%,特异度为87.2%,Youden指数为38.6%,符合率为69.6%;阳性预测值为77.1%,阴性预测值为87.2%,阳性似然比为3.857,阴性似然比为0.581。无论睁眼还是闭眼状态,正常人的重心移动轨迹图以前后型为多见,颈性眩晕患者则以弥散型为多见。结论：闭眼时人体重心测试法能较准确地鉴别颈性眩晕患者与正常者,其真实性、可靠性及临床应用价值较好,已达到客观化、量化诊断颈性眩晕的基本要求。而睁眼状态时的漏诊率较高,难以满足临床诊断要求。     

Utility of urine reagent strip in screening women with incontinence for urinary tract infection

The aim of this study was to determine the utility of urine reagent strips in screening women with urinary incontinence for urinary tract infections. Subjects were all women presenting with urinary incontinence. A urine specimen was screened for urinary tract infection with a urine reagent strip and urine culture. Using the urine culture result as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the urine reagent strips were calculated. A total of 265 pairs of reagent strips and urine cultures were evaluated. Thirty-one cultures grew out of a single organism; nine of these had a positive urine reagent strip, yielding a sensitivity of 29%. The specificity of the urine reagent strip was 99%, the positive predictive value was 82% and the negative predictive value was 92%. For women presenting with urinary incontinence, the sensitivity of a urine reagent test for diagnosing urinary tract infection was low.This study was performed without extramural financial support. This study was presented in poster format at the 32^nd Annual Meeting (August 28–30, 2002) of the International Continence Society in Heidelberg, GermanyEditorial Comment: The authors demonstrate the lack of utility of urine reagent strips. It has often been noticed that a discrepancy exists between office reagent strips and a urine culture. This study supports the routine use of a urinalysis and urine culture in the initial evaluation when evaluating women for urinary incontinence and voiding symptoms. This helps identify not only patients with urinary tract infections, but also those patients needing further evaluation for microscopic hematuria. Most commonly, patients present with both stress and urge incontinence, requiring an evaluation for all possible causes of their incontinence.     

冈上肌腱撕裂查体试验的诊断价值研究

目的:探讨6种常用查体试验对冈上肌腱撕裂的诊断价值,并评估这6种临床查体是否可以区分冈上肌腱部分或全层撕裂.方法:选择2017年6月至2020年9月因肩关节疾病行肩关节镜下手术治疗的91例患者,其中男49例,女42例;年龄31～68(50.8±11.0)岁;右侧70例,左侧21例.术前采用Hug-up试验、Jobe试验...     

Clinical Evaluation of Alpha Defensin Test Following Staged Treatment of Prosthetic Joint Infections

BackgroundDiagnosing persistent infection following staged treatment of prosthetic joint infection (PJI) is challenging. The alpha defensin (AD) test has been shown to be an accurate diagnostic test for the primary diagnosis PJI but has limited evaluation for use following a staged treatment of PJI. The goal of this study was to evaluate the diagnostic accuracy of AD testing following staged treatment of PJI before reimplantation surgery and to determine if negative AD test predicted success following reimplantation using Delphi Criteria at time of last follow-up.MethodsPatients who underwent AD testing prior to reimplantation after staged treatment of PJI (n = 52) were reviewed. Preoperative data (AD result, synovial fluid [SF], C-reactive protein level [mg/L], SF culture, SF white blood cell count, % of polymorphonuclear lymphocytes, serum C-reactive protein/erythrocyte sedimentation rate) and intraoperative data (purulence and tissue culture) were reviewed and used to classify patients using 2018 Musculoskeletal Infectious Disease Society criteria for infection, which was then used as a gold standard test to calculate diagnostic accuracy.Chart review was used to determine if patients who underwent reimplantation surgery would go on to treatment failure as defined by Delphi Criteria.ResultsThe sensitivity and specificity of AD test result as compared with Musculoskeletal Infectious Disease Society criteria in diagnosing PJI was calculated to be 71% and 97.78%. Positive predictive value was calculated to be 83.3%, and negative predictive value was calculated to be 95.65%.Patients who underwent reimplantation (46/52 patients) all had negative AD test results, and 9/46 or 19.5% would have treatment failure as defined by the Delphi Criteria with an average follow-up of 588 days.ConclusionAD demonstrates high specificity and negative predictive value, with low sensitivity when utilized after staged treatment of PJI. Further investigation of this and other diagnostic tests following staged treatment of PJI is needed. Additionally, validated criteria used to identify persistent infection following staged treatment of PJI are required.