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101.

Background Context

There is growing concern that the microbial profile of surgical site infection (SSI) in the setting of prophylactic vancomycin powder may favor more resistant and uncommon organisms.

Purpose

To demonstrate the impact of prophylactic intraoperative vancomycin powder on microbial profile, antibiotic regimen, length of stay (LOS), and reoperation rate in spine surgical site infection.

Study Design and/or Setting

Retrospective cohort study. Patient Sample: the study included 115 postoperative spine patients who were required to return to the operating room for SSI.

Outcome Measures

The outcome measures were microbial profile, reoperation rate, antibiotic regimen, and LOS for patients with postoperative spine infection who either did (treated) or did not (untreated) receive prophylactic vancomycin powder during their index procedure.

Methods

A retrospective review of patients who underwent posterior thoracic and/or lumbar spine surgery between 2010 and 2017 was conducted. Those undergoing surgical treatment of SSI were identified, and patients were divided into two groups - those who were treated with intraoperative vancomycin (treated) and those who were not (untreated). The organism profile for each group was compared. The average LOS, reoperation rate, and number of patients requiring more than 1 antibiotic were calculated for each patient in both groups.

Results

There were 5,909 procedures performed. One hundred and fifteen SSIs were identified, resulting in a 1.9% infection rate. Prophylactic vancomycin powder was used in the index procedure for 42 of those cases. 23.8% of cultures in the vancomycin group were polymicrobial and 16.7% were gram-negative compared with 9.6% (p=0.039) and 4.1% (p=0.021) in the untreated group, respectively. In the vancomycin-treated group, 26.1% of patients underwent repeat irrigation and debridement compared with 38.4% in the untreated group (p=0.184). The percentage of patients in the treatment and untreated group who required more than 1 antibiotic was 26.0% and 26.1%, respectively (p=0.984). Mean LOS in the treatment group was 8.0 versus 7.9 for the untreated group (p=0.945)

Conclusions

In this series, vancomycin powder was associated with a higher prevalence of gram-negative and polymicrobial organisms in patients that ultimately developed postoperative SSI. However, this did not adversely affect the need for multiple reoperations, antibiotic regimen, or LOS for these patients.  相似文献   
102.

Background and purpose:

Adding spironolactone to standard therapy in heart failure reduces morbidity and mortality, but the underlying mechanisms are not fully understood. We analysed the effect of canrenone, the major active metabolite of spironolactone, on myocardial contractility and intracellular calcium homeostasis.

Experimental approach:

Left ventricular papillary muscles and cardiomyocytes were isolated from male Wistar rats. Contractility of papillary muscles was assessed with force transducers, Ca2+ transients by fluorescence and Ca2+ fluxes by electrophysiological techniques.

Key results:

Canrenone (300–600 µmol·L−1) reduced developed tension, maximum rate of tension increase and maximum rate of tension decay of papillary muscles. In cardiomyocytes, canrenone (50 µmol·L−1) reduced cell shortening and L-type Ca2+ channel current, whereas steady-state activation and inactivation, and reactivation curves were unchanged. Canrenone also decreased the Ca2+ content of the sarcoplasmic reticulum, intracellular Ca2+ transient amplitude and intracellular diastolic Ca2+ concentration. However, the time course of [Ca2+]i decline during transients evoked by caffeine was not affected by canrenone.

Conclusion and implications:

Canrenone reduced L-type Ca2+ channel current, amplitude of intracellular Ca2+ transients and Ca2+ content of sarcoplasmic reticulum in cardiomyocytes. These changes are likely to underlie the negative inotropic effect of canrenone.  相似文献   
103.
104.
Bedwetting and behavioural and/or emotional problems   总被引:2,自引:0,他引:2  
Objective: To assess the link between enuresis nocturna and the severity of behavioural and/or emotional problems in Dutch children and the course of these problems. Setting: West-Mine Region in the Netherlands. Subjects and methods: Prospective cohort study involving 66 of the 80 bedwetting children from all 1652 children born in 1983 in this region. After 1 y, contact was still possible with 64 of the enuretics. We used the Dutch version of the Child Behaviour Checklist (CBCL) and a questionnaire about bedwetting. Results: The mean T-score for Total Problems (CBCL score) in 1992 (M1; mean age 8. 6) was 52. 1, and 1 y later was 49. 2 (M2). There was no significant difference in the CBCL scores for Ml, M2 and a matching group from the Dutch CBCL norm population, either in the group who remained wet or in the group who became dry. There were no differences between the sexes. There was no link between the severity of behavioural and emotional problems and the frequency of bedwetting. However, more children with bedwetting than expected were in the clinical range. Conclusion: There was no difference in behavioural and/or emotional problems between the first and the second measurement and the matching group from the CBCL norm group. There were no differences in behavioural and/or emotional problems between primary and secondary bedwetters, nor were there any consequences related to the frequency of bedwetting.  相似文献   
105.
OBJECTIVE: To determine how young children changed their overall diet when they changed their fat intake after 3 months of participating in a nutrition education demonstration study designed to lower low-density lipoprotein cholesterol and cardiovascular risk. METHODS: Three 24-hour dietary recalls were collected from 303 4- to 10-year-old children at baseline and 3 months later. At both times, mean number of servings from food groups, grams of fat contributed from food groups, and intake of calories and nutrients were calculated and compared among quartiles of children formed according to change in their percent of calories from total fat after 3 months. RESULTS: Children who reduced their percent of calories from total fat most (ie, by an average of 8.5%) after 3 months consumed fewer servings from meats, eggs, dairy, fats/oils, and breads but tended to increase their number of servings from lower-fat foods within those food groups, particularly from dairy foods. These children also increased their mean intake of fruits, vegetables, and desserts, and maintained average intakes of all nutrients (except vitamin D) in excess of two thirds of the respective recommended dietary allowance. CONCLUSIONS: Young children who reduced their percent of calories from total fat in accordance with the current National Cholesterol Education Program recommendations accomplished this by reducing their overall intake of higher-fat foods, replacing higher-fat foods with lower-fat foods within several food groups, particularly within the dairy group (eg, drinking skim milk instead of whole milk) and by consuming more servings of fruits, vegetables, and very-low-fat desserts. These behaviors did not compromise their mean calorie or nutrient intakes, showing that it is possible for young children to lower their fat intake safely to reduce their risk of future heart disease.  相似文献   
106.
107.
108.

Background  

In vivo studies were conducted to quantify the effectiveness of low-level direct electric current for different amounts of electrical charge and the survival rate in fibrosarcoma Sa-37 and Ehrlich tumors, also the effect of direct electric in Ehrlich tumor was evaluate through the measurements of tumor volume and the peritumoral and tumoral findings.  相似文献   
109.
目的:通过探讨血卟啉衍生物光动力学效应对人鼻咽癌细胞株CNE2的生物作用,为光动力治疗放、化疗效果较差的鼻咽癌提供理论依据。方法:实验于2005-10/2006-06在南方医科大学南方医院肿瘤生物治疗中心实验室完成。对体外培养的人鼻咽癌细胞株CNE2分为光处理和无光处理各8个实验组及各分别设对照组和空白对照组,实验组分别加入0.5,1.0,1.5,2.0,2.5,3.0,3.5,4.0mg/L血卟啉衍生物100μL,每组设7个复孔;孵育4h,对照组除不加光敏剂外其他与实验组相同,空白对照组只加培养基不加细胞和光敏剂。光处理实验组给予波长为630nm的半导体激光进行照射,照射的功率密度为20mW/cm2,照射能量密度分别为20,10,5,2J/cm2,继续孵育24h,用四唑盐(MTT)比色法测定细胞存活率。细胞存活率(%)=(实验组A值-空白对照组A值)/(对照组A值-空白对照组A值)×100%。每次实验重复3次,取平均值。结果:①血卟啉衍生物与CNE2细胞共同孵育后,采用630nm的半导体激光照射可对其产生杀伤作用,杀伤作用大小与血卟啉衍生物的浓度和激光剂量成正相关(P<0.01),但血卟啉衍生物浓度达2.5mg/L以上时杀伤细胞作用无显著增加。激光能量为20J/cm2,血卟啉衍生物的浓度为2.5mg/L时,其杀伤CNE2细胞的作用最明显。②在加入血卟啉衍生物而无激发光的情况下,血卟啉衍生物对鼻咽癌细胞生存不产生明显影响(P>0.05)。结论:血卟啉衍生物介导的光动力在体外可以对CNE2细胞产生杀伤效应,在一定范围内杀伤作用大小与血卟啉衍生物的浓度和激光剂量成正相关。  相似文献   
110.

Background

High tibial osteotomy (HTO) re-aligns the weight-bearing axis (WBA) of the lower limb. The surgery reduces medial load (reducing pain and slowing progression of cartilage damage) while avoiding overloading the lateral compartment. The optimal correction has not been established. This study investigated how different WBA re-alignments affected load distribution in the knee, to consider the optimal post-surgery re-alignment.

Methods

We collected motion analysis and seven Tesla MRI data from three healthy subjects, and combined this data to create sets of subject-specific finite element models (total = 45 models). Each set of models simulated a range of potential post-HTO knee re-alignments. We shifted the WBA from its native alignment to between 40% and 80% medial–lateral tibial width (corresponding to 2.8°–3.1° varus and 8.5°–9.3° valgus), in three percent increments. We then compared stress/pressure distributions in the models.

Results

Correcting the WBA to 50% tibial width (0° varus–valgus) approximately halved medial compartment stresses, with minimal changes to lateral stress levels, but provided little margin for error in undercorrection. Correcting the WBA to a more commonly-used 62%–65% tibial width (3.4°–4.6° valgus) further reduced medial stresses but introduced the danger of damaging lateral compartment tissues. To balance optimal loading environment with that of the historical risk of under-correction, we propose a new target: WBA correction to 55% tibial width (1.7°–1.9° valgus), which anatomically represented the apex of the lateral tibial spine.

Conclusions

Finite element models can successfully simulate a variety of HTO re-alignments. Correcting the WBA to 55% tibial width (1.7°–1.9° valgus) optimally distributes medial and lateral stresses/pressures.  相似文献   
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