Topical adjuvants incompletely remove adherent Staphylococcus aureus from implant materials

Adjuvant treatments including Betadine, Dakin's solution (sodium hypochlorite), or hydrogen peroxide (H₂O₂) have been attempted to eradicate prosthetic joint infection caused by biofilm or intracellular bacteria. The purpose of this study was to evaluate the in vitro abilities of chemical adjuvants to decrease Staphylococcus aureus (S. aureus) biofilm presence on orthopaedic implant grade materials, including titanium, stainless steel, and cobalt chrome. S. aureus biofilms were grown for 48 h and evaluated for baseline colony forming units/centimeter squared (CFU/cm²) and compared to treatments with Betadine, Dakin's solution, H₂O₂, or 1% chlorine dioxide (ClO₂). Control discs (n = 18) across all metals had an average of 4.2 × 10⁷ CFU/cm². All treatments had statistically significant reductions in CFU/cm² when compared to respective control discs (p < 0.05). For all metals combined, the most efficacious treatments were Betadine and H₂O₂, with an average 98% and 97% CFU/cm² reduction, respectively. There were no significant differences between reductions seen with Betadine and H₂O₂, but both groups had statistically greater reductions than Dakin's solution and ClO₂. There was no change in antibiotic resistance patterns after treatment. Analysis of S. aureus biofilms demonstrated a statistically significant reduction in biofilm after a five‐minute treatment with the modalities, with an average two log reduction in CFU/cm². Statement of clinical significance: While statistically significant reductions in CFU/cm² were accomplished with chemical adjuvant treatments, the overall concentration of bacteria never fell below 10⁵ CFU/cm², leading to questionable clinical significance. Further techniques to eradicate biofilm should be investigated. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1599–1604, 2018.

     

Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review

Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low- and middle-income countries (LMICs) through a systematic review of the literature. We proposed a novel Three-Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.     

Influence of Age on the Clinical Outcome of Breast Cancer for Men and the Development of Second Primary Cancers

Background

Low incidence of breast cancer in men (BCM) (<?1% of all breast cancers) has led to a paucity of outcome data. This study evaluated the impact of age on BCM outcomes.

Methods

For this study, BCM patients treated between 2000 and 2011 were stratified by age (≤?65 or?>?65 years). Kaplan–Meier methods were used to compare overall survival (OS) and breast cancer-specific survival (BCSS). Competing-risk methods analyzed time to second primary cancers (SPCs), with any-cause death treated as a competing risk.

Results

The study identified 152 BCM patients with a median age of 64 years (range 19–96 years). The median body mass index (BMI) was 28 kg/m². Men age 65 years or younger (n?=?78, 51%) were more overweight/obese than men older than 65 years (n?=?74, 49%) (89% vs 74%, respectively; P?=?0.008). Both groups had similar nodal metastases rates (P?=?0.4), estrogen receptor positivity (P?=?1), and human epidermal growth factor receptor 2 (HER2)neu overexpression (P?=?0.6). Men 65 years of age or younger were more likely to receive chemotherapy (P?=?0.002). The median follow-up period was 5.8 years (range 0.1–14.4 years). The 5-year OS was 86% (95% confidence interval [CI] 80–93%), whereas the 5-year BCSS was 95% (95% CI 91–99%). The BCM patients 65 years of age and younger had better OS (P?=?0.003) but not BCSS (P?=?0.8). The 5-year cumulative incidence of SPC was 8.4% (95% CI 3.4–13.4%). The prior SPC rate was higher for men older than 65 years (n?=?20, 31%) than for those age 65 years or younger (n?=?7, 11%) (P?=?0.008). This did not account for differences in life years at risk. No difference was observed in SPC cumulative incidence stratified by age (P?=?0.3).

Conclusions

Men 65 years of age or younger received more chemotherapy and had improved OS, but not BCSS, compared with men older than 65 years. For all BCM, SPC is a risk, and appropriate screening may be warranted.

     

Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas

Purpose of review

Subdural hematomas (SDH) represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. SDH incidence increases with age; numbers of patients affected by SDH continue to rise with our aging population and increasing number of people taking antiplatelet agents or anticoagulation. Medical and surgical SDH management remains a subject of investigation.

Recent findings

Initial management of patients with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining ICP <?22 mmHg, CPP >?60 mmHg, MAP 80–110 mmHg, and PaO₂ >?60 mmHg, followed by rapid sequence intubation if necessary, and expedited acquisition of imaging to identify a space-occupying lesion. Patients are administered anti-seizure medications, and their antiplatelet medications or anticoagulation may be reversed if neurosurgical interventions are anticipated, or until hemorrhage is stabilized on imaging.

Summary

Medical SDH care focuses on (a) management of intracranial hypertension; (b) maintenance of adequate cerebral perfusion; (c) seizure prevention and treatment; (d) maintenance of normothermia, eucarbia, euglycemia, and euvolemia; and (e) early initiation of enteral feeding, mobilization, and physical therapy. Post-operatively, SDH patients require ICU level care and are co-managed by neurointensivists with expertise in treating increased intracranial pressure, seizures, and status epilepticus, as well as medical complications of critical illness. Here, we review various aspects of medical management with a brief overview of pertinent literature and clinical trials for patients diagnosed with SDH.

     

Review of the comparative effectiveness of radical prostatectomy,radiation therapy,or expectant management of localized prostate cancer in registry data

Summary

Evidence regarding the effectiveness of treatment for prostate cancer is primarily based on randomized controlled trials. Long-term outcomes are generally difficult to evaluate within experimental studies and may benefit from large pools of observational data. We conducted a systematic review of administrative and registry studies to evaluate the comparative effectiveness of treatment for clinically localized prostate cancer on overall and prostate-cancer specific mortality.