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Miroslav Kilian 《中华创伤杂志(英文版)》2016,19(3):176-178
We reported a 30 years old man who suffered a bite wound of the right hand in a fight. Two days after
the injury, he was admitted in emergency because of stab wound above the head of the third metacarpal
bone. He presented the swelling, redness, pain and fever. Primary revision confirmed only partial lesion of the extensor apparatus. During the following days, we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the third metacarpophalangeal joint. The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics. After resolution of clinical and laboratory findings, the wound was finally closed by delayed primary suture. Clenched fist injury is a medical emergency that requires immediate surgical revision. We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes. 相似文献
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Microevolution and patterns of dissemination of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans
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The natural history, microevolution, and patterns of interindividual transmission and global dissemination of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans were studied by population genetic analysis. The JP2 clone is strongly associated with aggressive periodontitis in adolescents of African descent and differs from other clones of the species by several genetic peculiarities, including a 530-bp deletion in the promoter region of the leukotoxin gene operon, which results in increased leukotoxic activity. Multilocus sequence analysis of 82 A. actinomycetemcomitans strains, 66 of which were JP2 clone strains collected over a period of more than 20 years, confirmed that there is a clonal population structure with evolutionary lineages corresponding to serotypes. Although genetically highly conserved, as shown by alignment of sequences of eight housekeeping genes, strains belonging to the JP2 clone had a number of point mutations, particularly in the pseudogenes hbpA and tbpA. Characteristic mutations allowed isolates from individuals from the Mediterranean area and from West Africa, including the Cape Verde Islands, to be distinguished. The patterns of mutations indicate that the JP2 clone initially emerged as a distinct genotype in the Mediterranean part of Africa approximately 2,400 years ago and subsequently spread to West Africa, from which it was transferred to the American continents during the transatlantic slave trade. The sustained exclusive colonization of individuals of African descent despite geographical separation for centuries suggests that the JP2 clone has a distinct host tropism. The colonization of family members by JP2 clone strains with unique point mutations provides strong evidence that there is intrafamilial transmission and suggests that dissemination of the JP2 clone is restricted to close contacts. 相似文献
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Tan J Rüttiger L Panford-Walsh R Singer W Schulze H Kilian SB Hadjab S Zimmermann U Köpschall I Rohbock K Knipper M 《Neuroscience》2007,145(2):715-726
The molecular changes following sensory trauma and the subsequent response of the CNS are poorly understood. We focused on finding a molecular tool for monitoring the features of excitability which occur following acoustic trauma to the auditory system. Of particular interest are genes that alter their expression pattern during activity-induced changes in synaptic efficacy and plasticity. The expression of brain-derived neurotrophic factor (BDNF), the activity-dependent cytoskeletal protein (Arg3.1/arc), and the immediate early gene c-Fos were monitored in the peripheral and central auditory system hours and days following a traumatic acoustic stimulus that induced not only hearing loss but also phantom auditory perception (tinnitus), as shown in rodent animal behavior models. A reciprocal responsiveness of activity-dependent genes became evident between the periphery and the primary auditory cortex (AI): as c-Fos and BDNF exon IV expression was increased in spiral ganglion neurons, Arg3.1/arc and (later on) BDNF exon IV expression was reduced in AI. In line with studies indicating increased spontaneous spike activity at the level of the inferior colliculus (IC), an increase in BDNF and GABA-positive neurons was seen in the IC. The data clearly indicate the usefulness of Arg3.1/arc and BDNF for monitoring trauma-induced activity changes and the associated putative plasticity responses in the auditory system. 相似文献
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Jason Le Christopher P. Roche Wen Fan Emilie V. Cheung Dean W. Ziegler Steven I. Grindel Christopher M. Kilian Rick F. Papandrea 《Seminars in Arthroplasty》2022,32(3):613-622
BackgroundInstability after primary reverse total shoulder arthroplasty (rTSA) is a rare but serious complication, potentially resulting in revision surgery. The causes of instability after rTSA are multifactorial and sometimes unknown. The goal of this study is to analyze an international database of one-platform shoulder prosthesis and conduct a logistic multivariate regression analysis to identify the factors associated with instability after primary rTSA and quantify the 2-year minimum clinical outcomes of patients with and without instability.MethodsA total of 5631 primary rTSA patients were analyzed from the international database of single rTSA prosthesis to quantify clinical outcomes at 2-year minimum follow-up for patients with and without instability. rTSA patients were divided into 2 cohorts based on if they were stable or unstable, and a subanalysis was conducted for patients who were unstable early (<6 months) and also unstable late (>6 months). For both stable and unstable rTSA patients, univariate and multivariate analyses were performed to quantify the patient, implant, and operative risk factors associated with instability after rTSA.ResultsFifty-five of the 5631 primary rTSA shoulders were reported to be unstable, with an overall instability rate of 0.98%. Female patients had an instability rate of 0.60% (21/3496), which was significantly lower (P < .0001) than the 1.63% instability rate for male patients (34/2085). Patients with subscapularis repair had an instability rate of 0.45% (10/2222), which was significantly lower (P = .0052) than the 1.17% instability rate of patients without a subscapularis repair (37/3161). Multivariate analysis identified numerous risk factors for instability, including younger age at the time of surgery, the use of cemented humeral fixation, larger glenosphere diameters, expanded/lateralized center of rotation glenospheres, and not repairing the subscapularis.DiscussionOur study demonstrated that patients with instability had significantly worse clinical outcomes, more pain, and worse function and range of motion as compared to rTSA patients who were stable. The univariate and multivariate analyses identified numerous patient, implant, and operative risk factors associated with instability. A patient with 1 or more of these identified parameters has an increased risk for instability, and that recognition is useful for patient counseling and consideration of repair of the subscapularis, when possible. 相似文献
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R. Gologan V.M. Ginter N. Ising A.K. Kilian U. Obertacke Dr. U. Schreiner 《Der Unfallchirurg》2014,117(1):48-53