Infectious sacroiliitis: Retrospective analysis of 18 case patients

Introduction

Few infectious sacroiliitis reports are available in the literature. There is no standard clinical presentation, and diagnosis and treatments are therefore usually delayed. We aimed to describe this infection.

Distance traveled to undergo revision shoulder arthroplasty is impacted by patient demographics and exceeds that of primary shoulder arthroplasty

BackgroundPrevious research has highlighted disparities in access to and outcomes following shoulder arthroplasty. The purpose of this study is to compare travel distance for primary vs. revision surgery and to determine the relationships between travel distance to undergo revision shoulder arthroplasty and patient demographics and postoperative adverse outcomes. We hypothesized that older patients, those with increased medical comorbidities, and those with greater financial resources would travel farther for surgery.MethodsThe Healthcare Cost and Utilization Project, American Hospital Association, and UnitedStatesZipCodes.org Enterprise data sets were compiled to collect data on patient demographics, operation performed, and postoperative adverse outcomes. Population-weighted zip code centroid points of patients’ residences as well as hospital coordinates were used to approximate the distance traveled to undergo shoulder arthroplasty. Kruskal-Wallis tests and logistic regression analyses were used to analyze the relationship between travel distance and patients’ demographics and postoperative outcomes.ResultsPatients traveled farther to undergo revision shoulder arthroplasty than to undergo primary shoulder arthroplasty (P = .0001). Among patients who underwent revision operations, older age (P = .0001) and increased medical comorbidities (P = .003) were associated with decreased travel distance. White patients and those with commercial insurance traveled farther to receive care (P = .0001). There were no clinically significant associations between postoperative outcomes following revision surgery and travel distance.ConclusionPatients may travel farther to undergo revision surgery owing to patient preferences or because these complex operations are performed at fewer centers. Younger and healthier patients, white patients, and those with commercial insurance plans traveled farther to receive care. Future work is needed to determine the underlying causes of these disparities and whether it is patient preferences or systemic factors such as hospital density or access to high-quality health insurance that are influencing access to this specialized surgical care.     

Efficacy of a sclerostin antibody compared to a low dose of PTH on metaphyseal bone healing

We compared the effect of a sclerostin antibody to that of a clinically relevant dose of parathyroid hormone (PTH) in a rat model for metaphyseal bone healing. Screws of steel or poly methyl methacrylate (PMMA) were inserted bilaterally into the proximal tibia of young male rats. During 4 weeks the animals then received injections of either phosphate buffered saline (control), sclerostin antibody (25 mg/kg, twice weekly) or PTH (5 µg/kg, daily). The healing response around the screws was then assessed by mechanical testing and X‐ray microtomography (µCT). To distinguish between effects on healing and general effects on the skeleton, other untraumatized bone sites and serum biomarkers were also assessed. After 4 weeks of treatment, PTH yielded a 48% increase in screw pull‐out force compared to control (p = 0.03), while the antibody had no significant effect. In contrast, the antibody increased femoral cortical and vertebral strength where PTH had no significant effect. µCT showed only slight changes that were statistically significant for the antibody mainly at cortical sites. The results suggest that a relatively low dose of PTH stimulates metaphyseal repair (screw fixation) specifically, whereas the sclerostin antibody has wide‐spread effects, mainly on cortical bone, with less influence on metaphyseal healing. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:471–476, 2014.     

Using the learning disability screening questionnaire to help identify people with an intellectual disability in homeless services

Background

We explored the accuracy of using the learning disability screening questionnaire (LDSQ) in services for people experiencing homelessness in the United Kingdom.

Method

We examined the concordance between the LDSQ outcomes and assessments of intellectual disability. Seventy adults experiencing homelessness completed the LDSQ. Staff completed the LDSQ and a measure of adaptive functioning for 38 of this group. Nine participants received an intellectual assessment.

Results

Sensitivity and specificity for the LDSQ when completed by staff was 83% and 96% respectively and 50% and 92% when completed by the individual. Seven people had intellectual and adaptive functioning in the intellectual disability range.

Conclusion

The results suggest that the LDSQ would be an appropriate and beneficial screening tool to use within services for people experiencing homelessness. More accurate results would be likely if it were completed by staff.     

Tolerability,pharmacokinetics and pharmacodynamics of TA-8995, a selective cholesteryl ester transfer protein (CETP) inhibitor,in healthy subjects

Aims

Two double-blind, randomized studies were conducted to assess the tolerability, pharmacokinetics and pharmacodynamics of oral TA-8995, a new cholesteryl ester transfer protein (CETP) inhibitor, in healthy subjects.

Methods

Study 1: Subjects received single doses of TA-8995 or placebo (fasted). Doses were 5, 10, 25, 50 (fed/fasted), 100 and 150 mg (Caucasian males, 18–55 years), 25 mg (Caucasian males, > 65 years and Caucasian females, 18–55 years), 25, 50, 100 and 150 mg (Japanese males, 18–55 years). Study 2: Caucasian males (18–55 years) received 1, 2.5, 10 or 25 mg once daily TA-8995 or placebo for 21–28 days. Blood and urine for pharmacokinetics and/or pharmacodynamics were collected. Tolerability was assessed by adverse events, vital signs, electrocardiograms and laboratory safety tests.

Results

Peak TA-8995 concentrations occurred approximately 4 h post-dose. Mean half-lives ranged from 81 to 166 h, without an obvious dose relationship. Exposure increased less than proportionally to dose. TA-8995 was not excreted in urine. Following 2.5 to 25 mg once daily dosing, TA-8995 demonstrated nearly complete inhibition of CETP activity (92–99%), increased high density lipoprotein-cholesterol (HDL-C) by 96 to 140% and decreased low density liporotein-cholesterol (LDL-C) by 40% to 53%. There were dose-related increases in apolipoproteins A-1 and E, HDL2-C and HDL3-C, and decreases in apolipoprotein B and lipoprotein A. There was no evidence of significant effects of age, gender, ethnicity or food on pharmacokinetics or pharmacodynamics. All doses were well tolerated.

Conclusions

TA-8995 is a potent CETP inhibitor and warrants further investigation.     

Does alcohol increase the risk of overdose death: the need for a translational approach

Background We argue for a translational approach to addiction science, using an important current research question as a case study. Case study What is the evidence in support of the hypothesis that alcohol increases the risk of a heroin/opiate overdose through a pharmacological interaction? Findings The positive epidemiological evidence shows that opiate overdose deaths rarely involve a single drug; that alcohol is the most common other drug involved; that there is a negative association between alcohol and morphine concentration at post mortem; and that post‐mortem levels of morphine are often below the levels expected of highly tolerant individuals. The evidence is consistent with the hypothesis that heroin users who drink may require less heroin to overdose than those who do not drink (all other factors being equal) because of a pharmacological interaction. However, the evidence is consistent with, and does not rule out, other causal (and non‐causal) pathways. Alcohol could be associated negatively with tolerance, or confounded by other factors. Experimental evidence is required which is unlikely to be obtained through further epidemiological study or through randomized clinical trials. Conclusions We believe that animal models could provide the key evidence to test the hypothesis for a ‘pharmacodynamic’ or ‘pharmacokinetic’ interaction, which could be corroborated in clinical challenge studies and epidemiological studies. Such a translational approach demands greater collaboration between addiction scientists from basic to applied science and from neuroscience to social science, and would be able to address other key research questions and hypotheses in addiction.     

Short- and long-term outcome after lung resection for invasive pulmonary aspergillosis

BACKGROUND: Lung resection for invasive pulmonary aspergillosis (IPA) is controversial. Neutropenia, thrombopenia and poor general condition may increase perioperative morbidity and mortality, and the redeeming benefit is questionable. Therefore we analyzed short- and long-term outcome after lung resection for IPA. METHODS: 41 patients with hematological disease underwent lung resection for suspected IPA: lobectomy (23 patients), wedge-resection (16) and enucleation (2). RESULTS: 4 (10%) patients developed major complications: pleural aspergillosis, bronchial stump insufficiency, severe bleeding, ARDS. 11 (27%) patients showed minor complications: pleural effusion (6), pneumothorax (2), seroma (2) and hematothorax (1). 30-day mortality was 10 % (4 of 41 patients): two died of bacterial septicemia, two of disseminated aspergillosis. One (2%) death was possibly surgery-related. IPA was cleared in 87% of patients, fungal relapse occurred in 4 (10%) patients. Overall survival was 65%, 58% and 40% at 6 months, 12 months and 5 years. CONCLUSION: Lung resection for IPA even in profound cytopenia is feasible with acceptable morbidity and mortality. Fungal infection can be cured in more than 80 % of patients. Long-term outcome can be achieved if the hematological disease is under control.