Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip

Background

The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery.

Materials and methods

A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups—135 with monomicrobial and 54 with polymicrobial infection.

Results

Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m² (p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0–10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0–27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p < 0.0001). Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence (OR 4.4; 95 % CI 1.18–16.37; p = 0.03).

Conclusions

Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful.

Level of evidence

Level III, therapeutic study.

     

Contact (kallikrein/kinin) system activation in whole human blood induced by low concentrations of α-Fe2O3 nanoparticles

Iron-oxide nanoparticles (NPs) generated by environmental events are likely to represent health problems. α-Fe₂O₃ NPs were synthesized, characterized and tested in a model for toxicity utilizing human whole blood without added anticoagulant. MALDI-TOF of the corona was performed and activation markers for plasma cascade systems (complement, contact and coagulation systems), platelet consumption and release of growth factors, MPO, and chemokine/cytokines from blood cells were analyzed. The coronas formed on the pristine α-Fe₂O₃ NPs contained contact system proteins and they induced massive activation of the contact (kinin/kallikrein) system, as well as thrombin generation, platelet activation, and release of two pro-angiogeneic growth factors: platelet-derived growth factor and vascular endothelial growth factor, whereas complement activation was unaffected. The α-Fe₂O₃ NPs exhibited a noticeable toxicity, with kinin/kallikrein activation, which may be associated with hypotension and long-term angiogenesis in vivo, with implications for cancer, arteriosclerosis and pulmonary disease.     

Periodontal attachment loss due to applying force by tongue piercing

This report describes lingual cortical plate loss of the two lower central incisors with second degree mobility in an 18.5-year-old patient. Seven millimeters of clinical attachment losses were detected. For the last 4.5 years, the patient has worn a tongue ornament. The spheres were pressed directly against the periodontal lesion. The metal bar was bent as empirical evidence of the excessive force. Dental practitioners should educate their patients about the risk of oral piercing.     

ASO Visual Abstract: Iterative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Mucinous Adenocarcinoma of the Appendix

Annals of Surgical Oncology -     

ASO Author Reflections: What to Expect After You Resect Diaphragm During CRS/HIPEC

Annals of Surgical Oncology -     

Comparison of complications,costs, and length of stay of three different lumbar interbody fusion techniques: an analysis of the Nationwide Inpatient Sample database

Background contextLumbar interbody fusion (LIF) techniques have been used for years to treat a number of pathologies of the lower back. These procedures may use an anterior, posterior, or combined surgical approach. Each approach is associated with a unique set of complications, but the exact prevalence of complications associated with each approach remains unclear.PurposeTo investigate the rates of perioperative complications of anterior lumbar interbody fusion (ALIF), posterior/transforaminal lumbar interbody fusion (P/TLIF), and LIF with a combined anterior-posterior interbody fusion (APF).Study design/settingRetrospective review of national data from a large administrative database.Patient samplePatients undergoing ALIF, P/TLIF, or APF.Outcome measuresPerioperative complications, length of stay (LOS), total costs, and mortality.MethodsThe Nationwide Inpatient Sample database was queried for patients undergoing ALIF, P/TLIF, or APF between 2001 and 2010 as identified via International Classification of Diseases, ninth revision codes. Univariate analyses were carried out comparing the three cohorts in terms of the outcomes of interest. Multivariate analysis for primary outcomes was carried out adjusting for overall comorbidity burden, race, gender, age, and length of fusion. National estimates of annual total number of procedures were calculated based on the provided discharge weights. Geographic distribution of the three cohorts was also investigated.ResultsAn estimated total of 923,038 LIFs were performed between 2001 and 2010 in the United States. Posterior/transforaminal lumbar interbody fusions accounted for 79% to 86% of total LIFs between 2001 and 2010, ALIFs for 10% to 15%, and APF decreased from 10% in 2002 to less than 1% in 2010. On average, P/TLIF patients were oldest (54.55 years), followed by combined approach (47.23 years) and ALIF (46.94 years) patients (p<.0001). Anterior lumbar interbody fusion, P/TLIF, and combined surgical costs were $75,872, $65,894, and $92,249, respectively (p<.0001). Patients in the P/TLIF cohort had the greatest number of comorbidities, having the highest prevalence for 10 of 17 comorbidities investigated. Anterior-posterior interbody fusion group was associated with the greatest number of complications, having the highest incidence of 12 of the 16 complications investigated.ConclusionsThese data help to define the perioperative risks for several LIF approaches. Comparison of outcomes showed that a combined approach is more expensive and associated with greater LOS, whereas ALIF is associated with the highest postoperative mortality. These trends should be taken into consideration during surgical planning to improve clinical outcomes.     

Isolated adrenal cryptococcosis,diagnosed by fine‐needle aspiration biopsy: A case report

This report documents a case of isolated adrenal gland cryptococcosis without the often reported component of concomitant meningitis or Addison's disease in an immune competent patient. Furthermore, both the patient's lung cancer and adrenal infection with cryptococcus were incidentally discovered during work‐up for syncope in the setting of hyponatremia. This case also underscores the diagnostic value of fine‐needle aspiration biopsy in this unusual presentation. Diagn. Cytopathol. 2014;42:899–901. © 2014 Wiley Periodicals, Inc.     

The Technology of Using Liquid Glass Mixture Waste for Reducing the Harmful Environmental Impact

The spent liquid glass mixture, which is widely used in foundries as a binder after knocking out of moldings, contains pieces of different sizes and strengths, and there is a strong silicate film on the sand grains themselves. The proposed regeneration plants, which provide for the removal of the silicate film by scrubbing, have low productivity and lead to abrasion of the grains themselves. For this reason, the knocked-out mixture is taken to the dump. As a result of the study of the state of the spent liquid glass mixture in the dump, it was found that, in the spent mixture that had lain for 8–10 years, under prolonged exposure to atmospheric precipitation at plus and minus temperatures, part of the silicate film dissolves and almost all monolithic pieces are destroyed. Further use of hydraulic regeneration allows us to reduce the film thickness and thereby reduce the percentage of liquid glass from 5–5.5% to 0.8–1.2%. This made it possible to select the composition of the molding sand for an automatic line, using the AlpHaset-process, which consists of 22–29% of liquid glass mixture from a dump, 65–72% of liquid glass, 5.5% of liquid glass, and a hardener in the amount of 0.55%.     

Lactoferrin Induces Erythropoietin Synthesis and Rescues Cognitive Functions in the Offspring of Rats Subjected to Prenatal Hypoxia

The protective effects of recombinant human lactoferrin rhLF (branded “CAPRABEL™”) on the cognitive functions of rat offspring subjected to prenatal hypoxia (7% O₂, 3 h, 14th day of gestation) have been analyzed. About 90% of rhLF in CAPRABEL was iron-free (apo-LF). Rat dams received several injections of 10 mg of CAPRABEL during either gestation (before and after the hypoxic attack) or lactation. Western blotting revealed the appearance of erythropoietin (EPO) alongside the hypoxia-inducible factors (HIFs) in organ homogenates of apo-rhLF-treated pregnant females, their embryos (but not placentas), and in suckling pups from the dams treated with apo-rhLF during lactation. Apo-rhLF injected to rat dams either during pregnancy or nurturing the pups was able to rescue cognitive deficits caused by prenatal hypoxia and improve various types of memory both in young and adult offspring when tested in the radial maze and by the Novel Object Recognition (NOR) test. The data obtained suggested that the apo-form of human LF injected to female rats during gestation or lactation protects the cognitive functions of their offspring impaired by prenatal hypoxia.