Risk factors and a prognostic model of hip periprosthetic infection recurrence after surgical treatment using articulating and non-articulating spacers

Purpose

The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence.

Methods

In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI.

Results

Patients with infection recurrence had increased levels of ESR and CRP (P?<?0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P?<?0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50 %, P?<?0.01) where Gram-negative bacteria were predominant (61.5 %, P?<?0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2 %, P?<?0.01).

Conclusions

Efficacy of the first step of two-stage revision was 64.1 %. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.

     

Local and Non-local Regularization Techniques in Emission (PET/SPECT) Tomographic Image Reconstruction Methods

Emission tomographic image reconstruction is an ill-posed problem due to limited and noisy data and various image-degrading effects affecting the data and leads to noisy reconstructions. Explicit regularization, through iterative reconstruction methods, is considered better to compensate for reconstruction-based noise. Local smoothing and edge-preserving regularization methods can reduce reconstruction-based noise. However, these methods produce overly smoothed images or blocky artefacts in the final image because they can only exploit local image properties. Recently, non-local regularization techniques have been introduced, to overcome these problems, by incorporating geometrical global continuity and connectivity present in the objective image. These techniques can overcome drawbacks of local regularization methods; however, they also have certain limitations, such as choice of the regularization function, neighbourhood size or calibration of several empirical parameters involved. This work compares different local and non-local regularization techniques used in emission tomographic imaging in general and emission computed tomography in specific for improved quality of the resultant images.     

Polymorphism of Metastasis Suppressor Genes MKK4 and NME1 in Kashmiri Patients with Breast Cancer

Genetic polymorphisms in metastatic suppressor genes like MKK4 and NME1 are not well studied in breast cancer. Hence, we analyzed the relationship between MKK4 and NME1 polymorphisms and breast cancer risk in Kashmir, India. The different genotypes of NME1 and MKK4 genes were analyzed by polymerase chain reaction and restriction fragment length polymorphism in 130 breast cancer cases and 200 age‐ and sex‐matched controls. Conditional logistic regression models were used to assess the association of various genotypes with breast cancer. In this study, we found an inverse association between MKK4 promoter polymorphism and breast cancer risk. As compared to TT (wild) genotype, individuals with TG (heterozygous) (OR = 0.32; 95% CI = (0.17–0.58) and GG (mutant) (OR = 0.13; CI = 0.04–0.40) genotypes showed decreased risk of breast cancer. When participants were classified on the basis of lymph node involvement, a strong association between NME1 heterozygous genotype (OR = 3.82; CI = (1.54–9.44) and breast cancer was found.     

DNA fingerprinting and antimicrobial susceptibility pattern of clinical and environmental Acinetobacter baumannii isolates: a multicentre study

Background and aim: The aims of this study were to establish antibiotic profile and the molecular epidemiology of Acinetobacter baumannii isolates, with considering the effectiveness of control infection measures across three hospitals in the Kurdistan, west part of Iran.

Methods: Fifty-four A. baumannii isolates were collected from patients and environmental specimens. Antibiotic susceptibility patterns (Antibio-type) were evaluated for 17 different antibiotics and MIC for imipenem was done. Isolates were assessed for the presence of metallo-beta-lactamases (MBLs), class 1 and 2 integrons, and integrated gene cassettes and bla_{OXA-likefamilies} genes. Repetitive-sequence-based PCR (REP-PCR) was done for analysing clonality and relativeness of isolates (REP-type).

Results: Antibiotic susceptibility patterns distinguished 11 distinct Antibio-types and REP-PCR showed three clusters with 20 subclusters, mostly belonged to two clonal subgroups, A1 and B1. bla_OXA-51 and bla_OXA-23 were detected in 100% (54/54) and 52% (28/54), respectively, while bla_OXA-24-like and bla_OXA-58 were not present in isolates. MBLs were not detected, but, however, high rate of imipenem resistance was observed (52%). MIC₉₀ of imipenem was 16 mg/ml. Class 1 integrons were detected in 11% (6/54) of isolates followed by 24% (13/54) of class 2. Both classes of integron genes were detected in 15% (8/54) of isolates. Integrated gene cassettes were in low level (11% of class 1 harboring isolates). Two arrays of gene cassettes were revealed, dfrA5-like and dfrA17-aadA5.

Conclusion: Infection control surveillance should be considered as a serious manner, even the superficial eradication of hospital acquired pathogens. MBL genes were not induced carbapenem resistance in studied hospital settings, but bla_{OXA-51 & 23} contributed in imipenem resistant. Integrons had a little share in resistance of A. baumannii isolates.     

Postcementation hypersensitivity: Scientific data versus dentists'' perceptions

PURPOSE: The purpose of this article was to obtain dentists' opinions via an Internet survey as to the prevalence, causes, and prevention of postcementation sensitivity and compare their responses with published data on the problem. MATERIALS AND METHODS: Information as to respondents opinions of postcementation sensitivity was obtained from an Internet survey asking about their experience and for a ranking of the importance of each of 15 factors. RESULTS: A total of 466 valid responses were received. The incidence of postcementation sensitivity was estimated to be less than 2% by more than 2/3 of the dentists. The factors considered "very important" in reducing sensitivity by more than 50% of the respondents were desiccation, luting agent, occlusion, provisional, and water spray. CONCLUSIONS: Comparing respondents' opinions with published clinical studies, the incidence of postcementation sensitivity appears to be underestimated. There is little published evidence to support the importance of antimicrobials, desensitizing, or bonding agents, although these are considered effective by some dentists. Many respondents consider luting agent to be an important variable.     

Histopathological changes of pancreas in patients with fibrocalculous pancreatopathy

A total of 20 pancreatic biopsy samples taken from Fibrocalculous Pancreatopathy previously known as Fibro Calculus Pancreatic Diabetes (FCPD) patients, a variant of Malnutrition Related Diabetes Mellitus (MRDM) or under 30 young diabetes attending hepatobiliary, surgical and out patient department of Bangladesh Diabetes, Endocrine and Metabolic (BIRDEM) hospital were processed for light microscopic examination. Four samples were subjected to Immunohistochemistry (IHC) staining using antibodies to T cell marker (CD3), B cell marker (CD20), anti apoptotic markers (bcl-2) and tumour suppressor gene marker p53. Light microscopic findings and IHC indicate an immune mediated injury of pancreatic tissue and increased evidence of apoptosis which possibly results in the development of diabetes in these patients.     

Dentists'' preferences of anterior tooth proportion—a Web-based study

PURPOSE: This study aimed to determine dentists' esthetic preferences of the maxillary anterior teeth as influenced by different proportions. The goal was to link choices to demographic data as to the experience, gender, and training of the dentist. METHOD AND MATERIALS: Computer-manipulated images of the 6 maxillary anterior teeth were generated from a single image and assigned to 5 tooth-height groups (very short, short, normal height, tall, and very tall). For each group, 4 images were generated by manipulating the relative proportion of the central incisors, lateral incisors, and canines according to the proportions 62% (or "golden proportion"), 70%, 80%, and "normal" or not further altered. The images were randomly ordered on a web page that contained a form asking for demographic data and fields asking for a ranking of the images. Dentists were asked via e-mail to visit the web page and complete the survey. The responses were tabulated and analyzed with repeated measures logistic regression with the alpha at 0.05. A subset of North American respondents was chosen for further analysis. RESULTS: A total of 549 valid responses were received and analyzed from dentists in 38 countries. There were statistically significant differences in all groups for the variables of proportion, group (tooth height), and their interaction. The 80% proportion was judged best for the Very Short and Short groups. Three of the choices were almost equally picked for the Normal Height and Tall groups, and the golden proportion was judged best for the Very Tall group. The variables of year of graduation, gender, professional activity, generalist or specialist, or number of patients were not significantly correlated with the choices for the North American respondents. CONCLUSIONS: Dentists preferred the 80 percent proportion when viewing short or very short teeth and the golden proportion when viewing very tall teeth. Golden proportion was worst for normal height or shorter teeth and the 80% proportion for tall or very tall teeth. They picked no clear-cut best for normal height or tall teeth, and their choices could not be predicted based on gender, specialist training, experience, or patient load.