Complications after spacer implantation in the treatment of hip joint infections

The aim of this retrospective study was to identify and evaluate complications after hip spacer implantation other than reinfection and/or infection persistence.Between 1999 and 2008, 88 hip spacer implantations in 82 patients have been performed. There were 43 male and 39 female patients at a mean age of 70 [43 - 89] years. The mean spacer implantation time was 90 [14-1460] days. The mean follow-up was 54 [7-96] months. The most common identified organisms were S. aureus and S. epidermidis. In most cases, the spacers were impregnated with 1 g gentamicin and 4 g vancomycin / 80 g bone cement.The overall complication rate was 58.5 % (48/82 cases). A spacer dislocation occurred in 15 cases (17 %). Spacer fractures could be noticed in 9 cases (10.2 %). Femoral fractures occurred in 12 cases (13.6 %). After prosthesis reimplantation, 16 patients suffered from a prosthesis dislocation (23 %). 2 patients (2.4 %) showed allergic reactions against the intravenous antibiotic therapy. An acute renal failure occurred in 5 cases (6 %). No cases of hepatic failure or ototoxicity could be observed in our collective. General complications (consisting mostly of draining sinus, pneumonia, cardiopulmonary decompensation, lower urinary tract infections) occurred in 38 patients (46.3 %).Despite the retrospective study design and the limited possibility of interpreting these findings and their causes, this rate indicates that patients suffering from late hip joint infections and being treated with a two-stage protocol are prone to having complications. Orthopaedic surgeons should be aware of these complications and their treatment options and focus on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition.     

PCR为基础的反向线点杂交及16S～23S rDNA间区测序分析5种少见类型奴卡菌

目的探讨5种新出现的奴卡菌种16S～23S rDNA内转录间隔区(internal transcribed spacer,ITS)DNA基因序列的多态性,筛查特异的奴卡菌种逆向线点杂交(reverse line blot,RLB)探针。方法对6例奴卡菌标本进行ITS基因扩增、克隆、测序,设计奴卡菌种特异探针及ITS间区rDNA基因特异的探针,进行以PCR为基础的RLB(PCR/RLB)杂交试验,不同的RLB型进行ITS基因测序分析,以鉴别不同的奴卡菌种及种内分型。结果发现2个Nocardia beijingensis菌株ITS间区有8个基因序列型,4个RLB型;N.thailandica有4个基因序列型及RLB型;N.blacklockiae有5个基因序列型,3个RLB型,其中N-bla RLBⅢ型与所有Nbla-ITS探针杂交没有信号;N.elegans有5个基因序列型,3个RLB型;N.vinacea有5个基因序列型,2个RLB型。结论通过PCR/RLB试验,准确的ITS基因测序认识了新出现的菌种,即N.beijingensis,N.blacklockiae,N.elegans,N.thailandica及N.vinacea。同时建立了可以大量筛查奴卡菌种的PCR/RLB方法,以进行快速临床诊断及流行病学研究。     

Heparin–Paclitaxel Conjugates Using Mixed Anhydride as Intermediate: Synthesis,Influence of Polymer Structure on Drug Release,Anticoagulant Activity and <Emphasis Type="BoldItalic">In Vitro</Emphasis> Efficiency

Purpose  The heparin–paclitaxel conjugates using amino acid as linker (HD2), with low anticoagulant activity, the similar anticancer activity as paclitaxel, offer great potential for further investigation. Methods  Two types of heparin–paclitaxel conjugates (HD) have been developed, in which O-acetylated heparin as carrier conjugates with paclitaxel by direct ester bond (HD1) and by inserting different amino acids as spacers, including valine, leucine, and phenylalanine (HD2a, HD2b, and HD2c), respectively. Specifically, mixed anhydride groups of carrier as activating intermediates mediate the synthesis of prodrugs. The HD conjugates are characterized by ¹H NMR, FT-IR and GPC. The percentage weight of drug and hydrolysis rate for HD are detected by UV and HPLC. The anticoagulant activity and cell cycle of MCF-7 of HD are measured by APTT and FCM, respectively. Results   HD2 conjugates show better solubility and faster hydrolysis rates than those of HD1. Meanwhile, the anticoagulant activity of HD is reduced and FCM analysis show that MCF-7 cells treated with HD are arrested in the G2/M phase of cell cycle. Conclusions  Amino acids as linkers between paclitaxel and carrier are appropriate to facilitate the release of paclitaxel from carrier. Mixed anhydrides mediate the synthesis of prodrugs and HD2 conjugates are expected to further investigate in vivo experiment. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Tinea circinata manus due to Microsporum gypseum in a HIV-positive boy in Uganda, east Africa

A 15-year-old HIV-positive Ugandan boy suffered from several dry and hyperkeratotic lesions of his left hand and forearm with circinated, erythematous and scaly morphology. Microsporum gypseum could be isolated as causative agent of this ringworm. Species differentiation was confirmed and specified by sequence analysis of the internal transcribed spacer of the ribosomal DNA. Successful topical treatment of the tinea manus was started with clotrimazole-containing ointment.     

临床常见毛孢子菌的鉴定

为了探讨临床常见毛孢子菌（Trichosporon spp.)的鉴定方法，在形态学、营养生理学试验的基础上对临床常见的毛孢子菌－皮瘤毛孢子菌（Trichosporon inkin)、皮毛孢子菌（Trichosporon cutaneum)及阿萨希毛孢子菌（Trichosporon asahii)进行核糖体核糖核酸（rRNA)基因（rDNA)的内转录间区（ITS）扩增，用限制性内切酶Cfr3I、NcoI对聚合酶链反应（PCR）产物进行限制性片段长度多态性（RFLP）分析及序列测定，发现用Cfr13I做酶切，皮毛孢子菌的RFLP带型和阿萨希毛孢子菌、皮瘤毛孢子菌的不同；用NcoI做酶切，皮瘤毛孢子菌的带型与另两者不一致，序列分析的结果与形态学、营养生理学试验一致。结果提示，温度试验、API 20C、RFLP及序列测定可用于鉴定临床常见的毛孢子菌。     

Foreign-body reaction to the Artelon CMC joint spacer: case report

The Artelon CMC spacer (Small Bone Innovations, Inc., Morrisville, PA) is a relatively new device that was developed for the treatment of basal joint arthritis. It is composed of a biodegradable polycaprolactone-based polyurethane urea that acts to resurface the distal part of the trapezium and stabilize the trapeziometacarpal joint by augmenting the joint capsule. This is a case report of a foreign-body tissue reaction to the Artelon CMC spacer.     

Thoughts and proposals for quality assurance in orthopedics in the community pharmacy

This review begins with an examination of the notion of quality in the industrial setting, its definition and the steps taken to achieve quality assurance. The review then considers what is meant by quality in the field of health, and in particular for orthopedic devices dispensed in a community pharmacy. Special attention is given to dispensing standard orthopedic devices; five aspects are considered: organization, personal competence, products, services, and relationship with the patient. The first aspect, organization, involves the selling area, stocks, different sizes and sale prices, and the introduction of new devices. Dispensing involves, reception and physical examination of the patient, information delivery, decision-making on the choice of an orthesis, measurement, trial and application, as well as complementary advice and completion of the patient's file. Quality is measured in terms of patient needs.     

Genetic similarity among pheromone and voltinism races of Ostrinia nubilalis (Hübner) (Lepidoptera: Crambidae)

The genetic variability of seven European corn borer populations, Ostrinia nubilalis, from North America and Europe was assessed by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) analysis and DNA sequencing. The nuclear ribosomal internal transcribed spacer 1 (ITS-1) region (≈ 500 base pair [bp]) and four mitochondrial (mtDNA) regions (1550 bp total) were examined. The smartweed borer, Ostrinia obumbratalis, and south-Western corn borer, Diatraea grandiosella, were used for comparisons. Of 106 restriction sites identified (80 in mtDNA and 26 in ITS-1), none differentiated geographical populations, pheromone races, or voltine ecotypes of the European corn borer. The lack of variation in the ITS-1 of European corn borer was confirmed by DNA sequence analysis. The genetic similarity of European corn borer populations, despite their wide geographical range and physiological differences, may be explained by a relatively recent origin for the voltinism and pheromone races, gene flow among races, and/or expansion from genetic bottlenecks.     

Schmerz und KieferorthopädieEine interdisziplinäre Betrachtung kybernetischer Zusammenhänge

Zusammenfassung Dysfunktionen der Kiefergelenke k?nnen im Kiefergelenk selbst, in benachbarten Strukturen wie der oberen Halswirbels?ule aber auch in weit entfernt liegenden Regionen wie dem Becken Schmerzen ausl?sen und unterhalten. Findet der Schmerztherapeut bei der Untersuchung Dysfunktionen und/oder Schmerzen der Kiefergelenke, so sollte er daran denken, dass durch das Kiefergelenk als m?glichem prim?ren L?sionsgelenk Schmerzen in anderen K?rperregionen ausgel?st und unterhalten werden k?nnen. H?ufig sind die Symptome bei chronischen Kiefergelenksdysfunktionen nicht oder nur schwer zu erkennen und nicht ausschlie?lich am Kiefergelenk selbst zu diagnostizieren, sodass der Untersucher neben der Kiefergelenksuntersuchung weitere Screeningverfahren ben?tigt, um kybernetische Zusammenh?nge herauszuarbeiten. Hier bieten sich vor allem Untersuchungen aus der manuellen Medizin und die “Applied Kinesiology” (AK) nach Goodheart an [1, 2, 3, 4, 7, 8, 9, 10, 13, 16]. Plato u. Kopp [10] fanden in einer Untersuchung, dass alle chronischen Schmerzpatienten (=100%) mit den Diagnosen “atypischer Gesichtsschmerz” und “chronischer Kopfschmerz” Dysfunktionen im Bereich der Okklusion (Zusammenbiss der Z?hne) und der Kiefergelenke aufwiesen. Dieses galt ebenso für Schmerzen im Bereich des Beckenbodens. 85% der chronisch kranken Patienten mit Schmerzen im Bereich des Nackens wiesen Dysfunktionen im kraniomandibul?ren System (CMS) auf. 50% der Patienten mit tiefen Kreuzschmerz litten an einer kraniomandibul?ren Dysfunktion (CMD). Epidemiologische Studien zeigen, dass 75–90% der Kinder bereits Kopfschmerzen haben. Bei 10% der Kinder kann eine Migr?ne diagnostiziert werden. Die Ursachen sind vielf?ltig, aber h?ufig auch mit Okklusionsst?rungen und kraniomandibul?ren Dysfunktionen verbunden, die sich bei Kindern wie Erwachsenen in gleicher Art und Weise diagnostizieren und therapieren lassen. Hier sind wir als Fachzahn?rzte für Kieferorthop?die, die wir durchschnittlich mehr Kinder als Erwachsene behandeln, besonders gefordert [3,13]. Der Berufsverband der Deutschen Kieferorthop?den (BDK) als Ansprechpartner bemüht sich in letzter Zeit besonders um M?glichkeiten der interdisziplin?ren und integrativen Zusammenarbeit mit Manualmedizinern, Kinder?rzten und Krankengymnasten.     

Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

BackgroundPosterior-stabilized antibiotic cement articulating spacers (PS spacers) reduce spacer mechanical complications in prosthetic knee infections (PKIs); however, joint dislocation after femoral cam fracture has been reported. We hypothesized that the rate of post-cam mechanical complications is lower in PS spacers with an endoskeleton-reinforced cam.MethodA retrospective study of PKIs using PS spacers with or without a Kirschner wire–reinforced cam (K-PS or nK-PS spacers, respectively) was conducted between 2015 and 2019. The rates of post-cam mechanical complications and reoperation, as well as risk factors for post or cam failure, were analyzed.ResultsThe cohort included 118 nK-PS and 49 K-PS spacers. All patients were followed up for 2 years. The rate of joint subluxation/dislocation after femoral cam fracture was lower in K-PS (0%) than in nK-PS spacers (17.8%; P = .002). The reoperation rate for spacer mechanical complications was lower in K-PS (0%) than in nK-PS spacers (11.9%; P = .008). The identified risk factors for femoral cam fractures were body mass index ≥25 kg/m², femoral spacer size ≤2, and surgical volume ≤12 resection arthroplasties per year.ConclusionThis preliminary study highlights that K-PS spacers have a lower rate of post-cam mechanical complications than nK-PS spacers. We recommend the use of PS spacers with endoskeleton-reinforced cam when treating PKIs performed by surgeons with lower surgical volumes, especially in patients with higher body mass index and smaller femoral spacer sizes.